Provider Demographics
NPI:1124086392
Name:LASALA, GERMAN G (MD)
Entity type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:G
Last Name:LASALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7459 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3477
Mailing Address - Country:US
Mailing Address - Phone:520-207-7296
Mailing Address - Fax:520-207-7651
Practice Address - Street 1:7459 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3477
Practice Address - Country:US
Practice Address - Phone:520-207-7296
Practice Address - Fax:520-207-7651
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ19934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F97687Medicare UPIN