Provider Demographics
NPI:1841378403
Name:LAZAR, RANDE HARRIS (MD)
Entity type:Individual
Prefix:DR
First Name:RANDE
Middle Name:HARRIS
Last Name:LAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RANDE
Other - Middle Name:
Other - Last Name:LAZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:791 ESTATE PLACE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-821-4300
Mailing Address - Fax:901-821-4373
Practice Address - Street 1:791 ESTATE PLACE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-821-4300
Practice Address - Fax:901-821-4373
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16275207Y00000X, 207Y00000X
TNMD016275174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3014587OtherVESTICA
530OtherTLC
TN0063113OtherBCBS
TN3014587Medicaid
62-0842872OtherTAX ID
62-0842872OtherCHAMPUS
62-0842872OtherTAX ID
3014587OtherVESTICA
TN3014587Medicaid