BRIAN A LASSETER MD PA
Ambulatory Health at Jensen Beach Blvd, Jensen Beach, FL

License number
Florida 19921220007
Category
Ambulatory Health
Type
Urgent Care
Owner
Name: DR. BRIAN LASSETER MD
Title: OWNER
Phone: (772) 334-1700
Address
Address
1801 NE Jensen Beach Blvd, Jensen Beach, FL 34957
National Provider ID: 1861796427
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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BRIAN A. LASSETER, M.D., PA

Jensen Beach, FL

Status:
Inactive
Industry:
Medical Doctor's Office
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Aug 25, 2003
Inactive since:
Sep 26, 2014
Addresses:
3339 NE Luna Ter, Jensen Beach, FL 34957 (Physical)
1801 NE Jensen Bch Blvd, Jensen Beach, FL 34957
State ID:
P03000094294
Business type:
Florida Profit Corporation
Director:
Brian A Lasseter Director, inactive, 3339 NE Luna Ter, Jensen Beach, FL 34957 (Physical)
Agent:
Brian Lasseter,3339 NE Luna Ter, Jensen Beach, FL 34957 (Physical)
EIN:
810630011

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