MEDICARE: DR. AMOS L. LASH SR. M.D.

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	208800000X	Urology Physician	G34981	CA
2	208800000X	Urology Physician	MD2009-0006	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD2009-0006	OTHER	NM	NEW MEXICO PHYSICIANS LICENSE
2	G34981	OTHER	CA	PHY SURG LICENSE

General Provider Information

NPI Number	:	1639133788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMOS L. LASH SR. M.D.

Provider Business Mailing Address
First Line	:	1304 E 32ND ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7252
Country	:	US
Telephone Number	:	575-534-0556
Fax Number	:	575-534-9107

Provider Business Practice Location Address
First Line	:	1304 E 32ND ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7252
Country	:	US
Telephone Number	:	575-534-0556
Fax Number	:	575-534-9107

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	05/27/2011

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