Provider Demographics
NPI:1689659401
Name:LAZO, ROBERT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:LAZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:390 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1767
Practice Address - Country:US
Practice Address - Phone:540-484-4800
Practice Address - Fax:540-484-4847
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101052449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005623120Medicaid
VA005633575Medicaid
VA010027144Medicaid
VA005633575Medicaid
VA010027144Medicaid
080005642Medicare ID - Type Unspecified
003360C63Medicare PIN
080006729Medicare PIN