Provider Demographics
NPI:1063452548
Name:LAZARUS, KIMBERLY DARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DARLENE
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11840 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3840
Mailing Address - Country:US
Mailing Address - Phone:832-912-7044
Mailing Address - Fax:832-912-7033
Practice Address - Street 1:12015 LOUETTA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1148
Practice Address - Country:US
Practice Address - Phone:281-664-2152
Practice Address - Fax:281-664-2152
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM18682080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178813501Medicaid