MEDICARE: LAZARO BOUZA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	ME0042893	FL

General Provider Information

NPI Number	:	1023323086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAZARO BOUZA MD PA

Provider Business Mailing Address
First Line	:	3611 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3636
Country	:	US
Telephone Number	:	305-226-4634
Fax Number	:	305-226-5154

Provider Business Practice Location Address
First Line	:	3611 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3636
Country	:	US
Telephone Number	:	305-226-4634
Fax Number	:	305-226-5154

Authorized Official
Title or Position	:	MEDICAL DOCTOR/PRESIDENT
Name	:	LAZARO BOUZA
Credential	:	M.D.
Telephone Number	:	305-226-4634

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	08/16/2010

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