Provider Demographics
NPI:1497957195
Name:LAZO, EDWARD C (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:LAZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SE 29TH PL
Mailing Address - Street 2:STE 200
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0488
Mailing Address - Country:US
Mailing Address - Phone:352-690-6813
Mailing Address - Fax:352-690-6859
Practice Address - Street 1:321 SE 29TH PL
Practice Address - Street 2:STE 200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0488
Practice Address - Country:US
Practice Address - Phone:352-690-6813
Practice Address - Fax:352-690-6859
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 69494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27966OtherBCBS
FL27966YMedicare PIN
FLG18398Medicare UPIN