1144288069 NPI number — DR. ANTHONY L LAZAR M.D.

Table of content: DR. ANTHONY L LAZAR M.D. (NPI 1144288069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144288069 NPI number — DR. ANTHONY L LAZAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAZAR
Provider First Name:
ANTHONY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144288069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1223 S GEAR AVE
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
WEST BURLINGTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52655-1682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-754-4004
Provider Business Mailing Address Fax Number:
319-753-5498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1223 S GEAR AVE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
WEST BURLINGTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52655-1682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-754-4004
Provider Business Practice Location Address Fax Number:
319-753-5498
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  23402 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00170916 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2201491 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37984 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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