MEDICARE: DR. THOMAS ANTON LASKO MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	CFE53160	CA

General Provider Information

NPI Number	:	1063473668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ANTON LASKO MD, PHD

Provider Business Mailing Address
First Line	:	2525 WEST END AVE
Second Line	:	STE 600
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1774
Country	:	US
Telephone Number	:	615-936-5372
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 WEST END AVE
Second Line	:	STE 600
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1774
Country	:	US
Telephone Number	:	615-936-5372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/01/2013

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