Provider Demographics
NPI:1568470144
Name:EUGENE A. LAMAZOR, M.D., INC.
Entity Type:Organization
Organization Name:EUGENE A. LAMAZOR, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-892-9100
Mailing Address - Street 1:4725 ENTERPRISE WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8967
Mailing Address - Country:US
Mailing Address - Phone:209-543-6279
Mailing Address - Fax:209-543-6280
Practice Address - Street 1:1108 WARD AVE
Practice Address - Street 2:BLDG. A SUITE 1
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8529
Practice Address - Country:US
Practice Address - Phone:209-892-9100
Practice Address - Fax:209-892-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18252208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG18252OtherMEDICAL LICENSE