Provider Demographics
NPI:1821098419
Name:PAGES, LAZARO J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAZARO
Middle Name:J
Last Name:PAGES
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 1:2837 STONE MILL CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6278
Mailing Address - Country:US
Mailing Address - Phone:937-429-1809
Mailing Address - Fax:
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3820
Practice Address - Country:US
Practice Address - Phone:937-426-0049
Practice Address - Fax:937-431-8140
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0115726Medicaid
OH550809679OtherFED TAX ID NUMBER
OH550809679OtherFED TAX ID NUMBER
OHF96961Medicare UPIN
OH0776066Medicare ID - Type Unspecified