Provider Demographics
NPI:1093863607
Name:LASALLE, JAMES R (DO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:LASALLE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-630-6071
Mailing Address - Fax:816-630-4465
Practice Address - Street 1:950 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1238
Practice Address - Country:US
Practice Address - Phone:816-630-6071
Practice Address - Fax:816-630-4465
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine