Provider Demographics
NPI:1336137215
Name:LAZARO, LADISLAS IV (MD)
Entity Type:Individual
Prefix:
First Name:LADISLAS
Middle Name:
Last Name:LAZARO
Suffix:IV
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 1:913 S COLLEGE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3060
Mailing Address - Country:US
Mailing Address - Phone:337-237-5008
Mailing Address - Fax:337-237-7950
Practice Address - Street 1:913 S COLLEGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3060
Practice Address - Country:US
Practice Address - Phone:337-237-5008
Practice Address - Fax:337-237-7950
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020490207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5U181DD88OtherGROUP MEMBER PTAN
LA1984663Medicaid
5U181Medicare ID - Type Unspecified
LA1984663Medicaid