Provider Demographics
NPI:1003443953
Name:LASER, DAVID JR (BS, MBA, CIT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LASER
Suffix:JR
Gender:M
Credentials:BS, MBA, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4628
Mailing Address - Country:US
Mailing Address - Phone:479-785-4083
Mailing Address - Fax:
Practice Address - Street 1:3700 W 65TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-8552
Practice Address - Country:US
Practice Address - Phone:479-806-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health