Provider Demographics
NPI:1275864803
Name:DONALD T. LAZARZ, M.D., P.A.
Entity Type:Organization
Organization Name:DONALD T. LAZARZ, M.D., P.A.
Other - Org Name:DONALD T. LAZARZ, M.D., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:DEBENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-622-5116
Mailing Address - Street 1:4151 SOUTHWEST FWY
Mailing Address - Street 2:715B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7312
Mailing Address - Country:US
Mailing Address - Phone:713-622-5116
Mailing Address - Fax:713-622-2684
Practice Address - Street 1:4151 SOUTHWEST FWY
Practice Address - Street 2:715B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7312
Practice Address - Country:US
Practice Address - Phone:713-622-5116
Practice Address - Fax:713-622-2684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN J. DEBENDER, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7182174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24272Medicare UPIN