Provider Demographics
NPI:1457453771
Name:ROIG, LAZARO (MD)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:ROIG
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 141893
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1893
Mailing Address - Country:US
Mailing Address - Phone:787-815-5734
Mailing Address - Fax:787-881-5161
Practice Address - Street 1:CARR # 2 KM 62.7 SECTOR CANDELARIA
Practice Address - Street 2:BO. SABANA HOYO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00688
Practice Address - Country:US
Practice Address - Phone:787-881-6969
Practice Address - Fax:787-881-6969
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14401208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI16043Medicare UPIN