Provider Demographics
NPI:1639120132
Name:DE JESUS LAZU, LUIS SOCORRO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:SOCORRO
Last Name:DE JESUS LAZU
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:HC #5 BOX 5115
Mailing Address - Street 2:MARTORELL
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:787-266-4689
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA #7
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-874-3395
Practice Address - Fax:787-874-3395
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR16034208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice