Healthcare Provider Details

I. General information

NPI: 1740914274
Provider Name (Legal Business Name): ALAN LAZZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 N 20TH ST UNIT 10054
PHOENIX AZ
85064-6004
US

IV. Provider business mailing address

5021 N 20TH ST UNIT 10054
PHOENIX AZ
85064-6004
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-001151
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: