Provider Demographics
NPI:1871530378
Name:LASDAY, STEPHEN D (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:LASDAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-2868
Mailing Address - Country:US
Mailing Address - Phone:941-753-9599
Mailing Address - Fax:941-755-0261
Practice Address - Street 1:1611 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2868
Practice Address - Country:US
Practice Address - Phone:941-753-9599
Practice Address - Fax:941-755-0261
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2382213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390315000Medicaid
FL390315000Medicaid
FL65447Medicare ID - Type Unspecified