Individual
DR. GLENMORE LASAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1148 NORMAN DR STE 3, MANTECA, CA 95336-5961
(209) 824-1555
(209) 464-2684
Mailing address
415 E HARDING WAY STE D, STOCKTON, CA 95204-6118
(209) 944-5750
(209) 464-2684
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA10197800
NJ
207RC0000X
Cardiovascular Disease Physician
Primary
A171671
CA
390200000X
Student in an Organized Health Care Education/Training Program
0
—
Other
Enumeration date
04/07/2014
Last updated
07/19/2022
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