Provider Demographics
NPI:1912196387
Name:RICHARD W. LAZARO, M.D. P.C.
Entity Type:Organization
Organization Name:RICHARD W. LAZARO, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LAZARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-522-7676
Mailing Address - Street 1:1131 MALL DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8191
Mailing Address - Country:US
Mailing Address - Phone:505-522-7676
Mailing Address - Fax:505-522-8121
Practice Address - Street 1:1131 MALL DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8191
Practice Address - Country:US
Practice Address - Phone:505-522-7676
Practice Address - Fax:505-522-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83-236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty