Provider Demographics
NPI:1124194220
Name:BLUEFIELD MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BLUEFIELD MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:LARENCE
Authorized Official - Last Name:LASKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-327-2568
Mailing Address - Street 1:PO BOX 1519
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1519
Mailing Address - Country:US
Mailing Address - Phone:304-327-2568
Mailing Address - Fax:304-324-0800
Practice Address - Street 1:510 CHERRY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3338
Practice Address - Country:US
Practice Address - Phone:304-327-2568
Practice Address - Fax:304-324-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV10952207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty