Individual
DR. JACOB RANDALL LASSITER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 REDSTONE AVE W STE 470, CRESTVIEW, FL 32536-6457
(850) 689-2229
Mailing address
550 REDSTONE AVE W STE 470, CRESTVIEW, FL 32536-6457
(850) 689-2229
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
24652
MS
207V00000X
Obstetrics & Gynecology Physician
Primary
ME140756
FL
390200000X
Student in an Organized Health Care Education/Training Program
MD.34009
AL
Other
Enumeration date
04/17/2013
Last updated
11/10/2021
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