Provider Demographics
NPI:1265751424
Name:LANZON, PAUL JAMES (PA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JAMES
Last Name:LANZON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3015 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-8777
Mailing Address - Country:US
Mailing Address - Phone:616-522-9110
Mailing Address - Fax:616-522-9114
Practice Address - Street 1:3015 S STATE RD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-9416
Practice Address - Country:US
Practice Address - Phone:616-522-9110
Practice Address - Fax:616-522-9114
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant