Individual
GERARD V LASALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1141 BEACH DR E, PORT ORCHARD, WA 98366-4937
(360) 895-4700
Mailing address
1643 NW 136TH AVE., BLDG: H, SUITE: 100 MSC 11607-0004, SUNRISE, FL 33323
(865) 500-1856
(865) 560-7110
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD00017511
WA
208D00000X
General Practice Physician
Primary
MD00017511
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0170816
LIWA
WA
01
—
0170825
LIWA
WA
01
—
0190073
LIWA
WA
01
—
2165LA
BSWA
WA
05
—
8328601
—
WA
01
—
LA1174
BSWA
WA
01
—
LA8001
BSWA
WA
Enumeration date
06/15/2006
Last updated
11/03/2023
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