Provider Demographics
NPI:1649387697
Name:RABANG, LAZARO (MD)
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:RABANG
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-9500
Mailing Address - Fax:515-643-9525
Practice Address - Street 1:4005 NW URBANDALE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7914
Practice Address - Country:US
Practice Address - Phone:515-643-9500
Practice Address - Fax:515-643-9525
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34793207R00000X
IAMD-34793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0266189Medicaid
IA237429OtherMIDLANDS CHOICE
IAI18862Medicare PIN
IAG22402Medicare UPIN
IA237429OtherMIDLANDS CHOICE