Provider Demographics
NPI:1083685531
Name:LAZARUS, LAWRENCE W (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:W
Last Name:LAZARUS
Suffix:
Gender:M
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:PO BOX 1968
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-1968
Mailing Address - Country:US
Mailing Address - Phone:505-820-2302
Mailing Address - Fax:505-982-4777
Practice Address - Street 1:2826 PLAZA VERDE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6512
Practice Address - Country:US
Practice Address - Phone:505-820-2302
Practice Address - Fax:505-982-4777
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001622084P0800X
NM2001-622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA8506Medicaid
NMNM00JJ88OtherBLUE CROSS
NMA8506Medicaid