Provider Demographics
NPI:1104861731
Name:LASKY, TIFFANY M (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:LASKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5130 GATEWAY BLVD E # CP
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1608
Mailing Address - Country:US
Mailing Address - Phone:915-215-4480
Mailing Address - Fax:915-215-5386
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-215-5300
Practice Address - Fax:915-215-8606
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1809208600000X, 2086S0127X
TXU7340208600000X, 2086S0102X
WV34492086S0102X, 208600000X
MI51010146152086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I812827Medicare PIN
TN103I817079Medicare PIN
TN3822462Medicare ID - Type Unspecified