MEDICARE: PETER S LAZARUS MD

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	208000000X	Pediatrics Physician	E7157	TX
2	208M00000X	Hospitalist Physician	E7157	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1392539	OTHER	TX	UHC PIN
5	10028668	OTHER	TX	AMERIGROUP PIN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	413475	OTHER	TX	PHCS PIN
8	00U87Z	OTHER	TX	BCBSTX GRP PIN
9	113052	OTHER	TX	SUPERIOR PIN
10	1640382	OTHER	TX	FIRSTHEALTH PIN
11	1750369203	OTHER		GRP NPI NUMBER
12	82V082	OTHER	TX	BCBSTX IND PIN
13	9239598	OTHER	TX	CIGNA PIN
14	117492100	OTHER	TX	FIRSTCARE PIN
15	4391266	OTHER	TX	AETNA PIN

General Provider Information

NPI Number	:	1518050608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER S LAZARUS MD

Provider Business Mailing Address
First Line	:	PO BOX 99371
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76199-0371
Country	:	US
Telephone Number	:	682-885-1855
Fax Number	:	682-885-7347

Provider Business Practice Location Address
First Line	:	6421 MCCART AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4702
Country	:	US
Telephone Number	:	817-263-7500
Fax Number	:	817-423-4140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	06/03/2013

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Directions to “ PETER S LAZARUS MD” Practice Location

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