Provider Demographics
NPI:1487880365
Name:SATHER, LARS THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:LARS
Middle Name:THOMAS
Last Name:SATHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:3133 PROFESSIONAL DR
Practice Address - Street 2:SUITE 20
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2463
Practice Address - Country:US
Practice Address - Phone:530-885-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19747363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19747OtherMEDICAL LICENSE