Provider Demographics
NPI:1639265838
Name:LASSELLE, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:LASSELLE
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0190
Mailing Address - Country:US
Mailing Address - Phone:509-865-6175
Mailing Address - Fax:
Practice Address - Street 1:240 DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1357
Practice Address - Country:US
Practice Address - Phone:509-882-4260
Practice Address - Fax:509-882-6088
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035782207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
12199OtherGROUP HEALTH
WA8125882Medicaid
911019392OtherCOMMERCIAL
LA9392OtherREGENCE
WA8125882OtherCHPW
WA118709OtherL & I
1306897681OtherNPI PROSSER MEMORIAL
ORWA203935OtherHEALTH NET PLAN OF OR
GAB16264Medicare ID - Type Unspecified
911019392OtherCOMMERCIAL
WA8125882Medicaid