Provider Demographics
NPI:1639133788
Name:LASH, AMOS L SR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMOS
Middle Name:L
Last Name:LASH
Suffix:SR
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 1:1304 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7252
Mailing Address - Country:US
Mailing Address - Phone:575-534-0556
Mailing Address - Fax:575-534-9107
Practice Address - Street 1:1304 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7252
Practice Address - Country:US
Practice Address - Phone:575-534-0556
Practice Address - Fax:575-534-9107
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34981208800000X
NMMD2009-0006208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2009-0006OtherNEW MEXICO PHYSICIANS LICENSE
CAG34981OtherPHY SURG LICENSE
CAA91648Medicare UPIN
G34981Medicare ID - Type Unspecified