Provider Demographics
NPI:1003883349
Name:LAZAR, GERALD MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MARTIN
Last Name:LAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4187 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3343
Mailing Address - Country:US
Mailing Address - Phone:801-272-1777
Mailing Address - Fax:801-322-3890
Practice Address - Street 1:2005 E 2700 S
Practice Address - Street 2:SUITE 180
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1700
Practice Address - Country:US
Practice Address - Phone:801-746-2297
Practice Address - Fax:801-322-3890
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT174906-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry