Provider Demographics
NPI:1851389001
Name:ZAGORIN, LAZARO (MDPA)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:ZAGORIN
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 BRIGGS ST
Mailing Address - Street 2:#300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1221
Mailing Address - Country:US
Mailing Address - Phone:210-928-7070
Mailing Address - Fax:210-928-9199
Practice Address - Street 1:94 BRIGGS ST
Practice Address - Street 2:#300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1221
Practice Address - Country:US
Practice Address - Phone:210-928-7070
Practice Address - Fax:210-928-9199
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G91ROtherBCBSTX
TX133435105Medicaid
TX00G91ROtherBCBSTX
TX133435105Medicaid