Provider Demographics
NPI:1326084203
Name:BOUZA, LAZARO (MD)
Entity Type:Individual
Prefix:DR
First Name:LAZARO
Middle Name:
Last Name:BOUZA
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 1:3611 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3636
Mailing Address - Country:US
Mailing Address - Phone:305-226-4634
Mailing Address - Fax:305-226-5154
Practice Address - Street 1:3611 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3636
Practice Address - Country:US
Practice Address - Phone:305-226-4634
Practice Address - Fax:305-226-5154
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042893207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047546700Medicaid
FLC02702Medicare UPIN
FL02537Medicare ID - Type Unspecified