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1619994423

NPI Code Detail

MEDICARE: DR. JERRY L. LASTER MD

MEDICARE: DR. JERRY L. LASTER MD

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	208600000X	Surgery Physician	G8234	TX
2	208D00000X	General Practice Physician	G8234	TX
3	207Q00000X	Family Medicine Physician	G8234	UT
4	207Q00000X	Family Medicine Physician	G8234	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00720965	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F0717	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619994423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY L. LASTER MD

Provider Business Mailing Address
First Line	:	PO BOX 742712
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2712
Country	:	US
Telephone Number	:	877-866-7123
Fax Number	:

Provider Business Practice Location Address
First Line	:	17218 PRESTON RD STE 2000
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-4018
Country	:	US
Telephone Number	:	877-866-7123
Fax Number	:	877-284-8933

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	06/28/2023

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Directions to “ DR. JERRY L. LASTER MD” Practice Location

Language	Start Address	Practice Location

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