Provider Demographics
NPI:1932267663
Name:LANZA, JOHN T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:LANZA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1801 SE HILLMOOR DR
Mailing Address - Street 2:SUITE B105
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7545
Mailing Address - Country:US
Mailing Address - Phone:772-398-9911
Mailing Address - Fax:772-398-4374
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:SUITE B105
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7545
Practice Address - Country:US
Practice Address - Phone:772-398-9911
Practice Address - Fax:772-398-4374
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0063810207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255054700Medicaid
FL255054700Medicaid
FL25054WMedicare PIN
F77289Medicare UPIN