Healthcare Provider Details

I. General information

NPI: 1912937210
Provider Name (Legal Business Name): ALLEN W LAZENBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N 20TH ST BLDG 3
OPELIKA AL
36801-5454
US

IV. Provider business mailing address

121 N 20TH ST BLDG 3
OPELIKA AL
36801-5454
US

V. Phone/Fax

Practice location:
  • Phone: 334-745-6271
  • Fax: 334-742-9879
Mailing address:
  • Phone: 334-745-6271
  • Fax: 334-742-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00018373
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: