MEDICARE: EARL LAMAR LASETER PA

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	363AS0400X	Surgical Physician Assistant	1157	SC
2	363AS0400X	Surgical Physician Assistant	0010-15947	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316043094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL LAMAR LASETER PA

Provider Business Mailing Address
First Line	:	PO BOX 1869
Second Line	:
City	:	FLETCHER
State	:	NC
Zip	:	28732-1869
Country	:	US
Telephone Number	:	828-687-5699
Fax Number	:	828-650-8076

Provider Business Practice Location Address
First Line	:	1330 BOILING SPRINGS RD
Second Line	:	SUITE 1600
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4201
Country	:	US
Telephone Number	:	864-582-6396
Fax Number	:	864-582-1608

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	05/04/2026

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