Provider Demographics
NPI:1700843885
Name:LANZA, DONALD C (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:LANZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 94TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2406
Mailing Address - Country:US
Mailing Address - Phone:727-573-0074
Mailing Address - Fax:
Practice Address - Street 1:550 94TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2406
Practice Address - Country:US
Practice Address - Phone:727-573-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88591207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48804OtherBCBS
FL48804OtherBCBS
FLE46965Medicare UPIN