Provider Demographics
NPI:1891806089
Name:LAZO, ERIC ULANDAY (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ULANDAY
Last Name:LAZO
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 1:6900 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-4400
Mailing Address - Country:US
Mailing Address - Phone:702-791-9000
Mailing Address - Fax:
Practice Address - Street 1:3301 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1835
Practice Address - Country:US
Practice Address - Phone:702-433-5296
Practice Address - Fax:702-433-5299
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11165207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505372Medicaid
NVCC8803OtherBLUE CROSS BLUE SHIELD
NVV100340Medicare PIN
NVCC8803OtherBLUE CROSS BLUE SHIELD