Provider Demographics
NPI:1013921899
Name:DAVID W LAZAN MD PA
Entity Type:Organization
Organization Name:DAVID W LAZAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:LAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-569-4464
Mailing Address - Street 1:1600 36TH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-569-4464
Mailing Address - Fax:772-569-5656
Practice Address - Street 1:1600 36TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-569-4464
Practice Address - Fax:772-569-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9647005OtherGHI
FLDD8912OtherRAILROAD MEDICARE
FL9647005OtherGHI