Provider Demographics
NPI:1629117080
Name:LAZAR, GABRIEL (DPM)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:LAZAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N LEE TREVINO DR STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5175
Mailing Address - Country:US
Mailing Address - Phone:915-593-3668
Mailing Address - Fax:915-593-5010
Practice Address - Street 1:1635 N LEE TREVINO DR STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5175
Practice Address - Country:US
Practice Address - Phone:915-593-3668
Practice Address - Fax:915-593-5010
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1228213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R7020OtherBC BS
U23567Medicare UPIN
TX8R7020OtherBC BS