Provider Demographics
NPI:1891769980
Name:LAZZARA, ROBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:LAZZARA
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 1:496 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-2604
Mailing Address - Country:US
Mailing Address - Phone:813-477-6359
Mailing Address - Fax:
Practice Address - Street 1:496 39TH AVE
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-2604
Practice Address - Country:US
Practice Address - Phone:813-477-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52093208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1647394OtherCIGNA
FL261013200Medicaid
FL1777261OtherUNITED
FL255192OtherSTAYWELL
FL58816OtherBCBS
FL134223953OtherHUMANA
FL279836OtherAVMED
FL225192OtherWELLCARE
FL3309685OtherAETNA
FLP00127976Medicare PIN