Provider Demographics
NPI:1528023009
Name:LASKER, BRUCE LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LAWRENCE
Last Name:LASKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CHERRY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3338
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
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 10952207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0093990000Medicaid
WVA71947Medicare UPIN
WV0093990000Medicaid