MEDICARE: BRIAN ANDREW LASSETER 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	207Q00000X	Family Medicine Physician	33303	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33303	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1871596981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ANDREW LASSETER MD

Provider Business Mailing Address
First Line	:	1801 NE JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-7233
Country	:	US
Telephone Number	:	772-334-1700
Fax Number	:	772-334-1703

Provider Business Practice Location Address
First Line	:	1801 NE JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-7233
Country	:	US
Telephone Number	:	772-334-1700
Fax Number	:	772-334-1703

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/27/2009

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