Provider Demographics
NPI:1740613041
Name:LAZARUS, JOSHUA PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:PAUL
Last Name:LAZARUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:729 N MEDICAL CENTER DR W
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6879
Practice Address - Country:US
Practice Address - Phone:559-320-0531
Practice Address - Fax:559-320-0539
Is Sole Proprietor?:No
Enumeration Date:2013-08-10
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA23072363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant