Individual
RICHARD JOHN LASSERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
353 N. 4TH 102, POCATELLO, ID 83201
(208) 478-7900
(208) 479-7901
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(208) 251-9093
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
9651486-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003792800
—
ID
01
—
49726
BLUE CROSS
ID
Enumeration date
10/04/2006
Last updated
02/09/2016
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