Provider Demographics
NPI:1427054022
Name:SASAKI, LARRY S (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:S
Last Name:SASAKI
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 1:1512 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3322
Mailing Address - Country:US
Mailing Address - Phone:318-746-7272
Mailing Address - Fax:318-746-7212
Practice Address - Street 1:1512 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3322
Practice Address - Country:US
Practice Address - Phone:318-746-7272
Practice Address - Fax:318-746-7212
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2024-08-07
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
LALA11148R208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1664766Medicaid
LA1664766Medicaid
F96920Medicare UPIN