Provider Demographics
NPI:1639305246
Name:LASH, DUSTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:LASH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 ROSS CLARK CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-9917
Mailing Address - Country:US
Mailing Address - Phone:334-239-0063
Mailing Address - Fax:
Practice Address - Street 1:2800 ROSS CLARK CIR STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-9917
Practice Address - Country:US
Practice Address - Phone:334-239-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0845207QS0010X, 207Q00000X
ALDO.1478207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL169149Medicaid
AL511-58601OtherBCBS OF ALABAMA