Provider Demographics
NPI:1982736781
Name:LAZARUS, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
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 1:801 N WEISGARBER RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2706
Mailing Address - Country:US
Mailing Address - Phone:865-588-1662
Mailing Address - Fax:865-588-2570
Practice Address - Street 1:801 N WEISGARBER RD
Practice Address - Street 2:SUITE 500
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2706
Practice Address - Country:US
Practice Address - Phone:865-588-1662
Practice Address - Fax:865-588-2570
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4581699174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB04836Medicare UPIN