Provider Demographics
NPI:1760421101
Name:LAZO-DIAZ, GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:LAZO-DIAZ
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1901 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1271
Practice Address - Country:US
Practice Address - Phone:956-687-5150
Practice Address - Fax:956-687-9546
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0370207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX42067104Medicaid
TX42067103Medicaid
TX8S7051OtherBLUE CROSS OF TX
TX8D8380Medicare PIN
TX42067104Medicaid
H22275Medicare UPIN
TX42067103Medicaid