Provider Demographics
NPI:1881785285
Name:LAZARUS, JEFFREY EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EDWARD
Last Name:LAZARUS
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 1:1220 UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-322-5333
Mailing Address - Fax:
Practice Address - Street 1:1220 UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-322-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046418L208000000X
CAG40298208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02815Medicare UPIN