Provider Demographics
NPI:1568420255
Name:LASICH, BETTY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:J
Last Name:LASICH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 MERCADO STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7311
Mailing Address - Country:US
Mailing Address - Phone:970-382-8800
Mailing Address - Fax:970-382-0122
Practice Address - Street 1:1 MERCADO STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7311
Practice Address - Country:US
Practice Address - Phone:970-382-8800
Practice Address - Fax:970-382-0122
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-03-08
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Provider Licenses
StateLicense IDTaxonomies
CO41535207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32451873Medicaid
CO1568420255OtherNPI
NM67772021Medicaid
CO32451873Medicaid
F80067Medicare UPIN