Basic Information
| Provider Information | |||||||||
| NPI: | 1104861731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LASKY | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 699 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376840699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397201 | ||||||||
| FaxNumber: | 4234397219 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 N STATE OF FRANKLIN RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397201 | ||||||||
| FaxNumber: | 4234397219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 08/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 3449 | WV | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 3449 | WV | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 1809 | TN | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0127X | 1809 | TN | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0127X | 5101014615 | MI | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.