Healthcare Provider Details

I. General information

NPI: 1578594180
Provider Name (Legal Business Name): MARTIN LAZORITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARTIN LAZORITZ

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD BOX 100371
GAINESVILLE FL
32610-0371
US

IV. Provider business mailing address

PO BOX 100371
GAINESVILLE FL
32610-0371
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-3681
  • Fax:
Mailing address:
  • Phone: 352-265-0301
  • Fax: 352-265-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME24085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: