Provider Demographics
NPI:1710004023
Name:L LAZARO IV APMC
Entity Type:Organization
Organization Name:L LAZARO IV APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-237-5008
Mailing Address - Street 1:913 S COLLEGE RD
Mailing Address - Street 2:110
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3060
Mailing Address - Country:US
Mailing Address - Phone:337-237-5008
Mailing Address - Fax:
Practice Address - Street 1:913 S COLLEGE RD
Practice Address - Street 2:110
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3060
Practice Address - Country:US
Practice Address - Phone:337-237-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020490207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA660002258OtherPALMETTO GBA - RAILROAD MEDICARE
LA5DD88OtherGROUP PTAN