Provider Demographics
NPI:1316043094
Name:LASETER, EARL LAMAR JR (PA)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:LAMAR
Last Name:LASETER
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BOILING SPRINGS RD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4201
Mailing Address - Country:US
Mailing Address - Phone:864-582-6396
Mailing Address - Fax:864-582-1608
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE 1600
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4201
Practice Address - Country:US
Practice Address - Phone:864-582-6396
Practice Address - Fax:864-582-1608
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1157363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0467PAMedicaid
SC0467PAMedicaid
SCAA16001223Medicare PIN