Provider Demographics
NPI:1669089223
Name:LAZARUS 3D, INC.
Entity type:Organization
Organization Name:LAZARUS 3D, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANEVELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-760-1805
Mailing Address - Street 1:3513 NW MINK PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3729
Mailing Address - Country:US
Mailing Address - Phone:541-760-1805
Mailing Address - Fax:
Practice Address - Street 1:3513 NW MINK PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3729
Practice Address - Country:US
Practice Address - Phone:541-760-1805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology