Healthcare Provider Details

I. General information

NPI: 1932168523
Provider Name (Legal Business Name): ANGEL AMADO LAZO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 S US HIGHWAY 1 STE C11
FORT PIERCE FL
34982-8143
US

IV. Provider business mailing address

2940 S US HIGHWAY 1 STE C11
FORT PIERCE FL
34982-8143
US

V. Phone/Fax

Practice location:
  • Phone: 772-466-6855
  • Fax: 772-464-6983
Mailing address:
  • Phone: 772-466-6855
  • Fax: 772-464-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME180081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: