Basic Information
| Provider Information | |||||||||
| NPI: | 1366498057 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASATER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840853 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136204000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1500 CITYWEST BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136204000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2005004540 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | N5800 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200055760A | 05 | OK | MEDICAID | P00881642 | 01 | TX | RAILROAD MEDICARE | OTHER | 1780 | 01 | MO | ANTHEM | OTHER | 212156801 | 05 | TX | MEDICAID | 8CG986 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 207232208 | 05 | MO | MEDICAID | 200326410A | 05 | KS | MEDICAID | P00224393 | 01 | RR MEDICARE | OTHER |