Healthcare Provider Details

I. General information

NPI: 1336229376
Provider Name (Legal Business Name): SCOTT GARY LAZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST DIVISION OF PEDIATRICS, INPATIENT
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

1117 E HALLANDALE BEACH BLVD
HALLANDALE FL
33009
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-6301
  • Fax: 954-985-1434
Mailing address:
  • Phone: 954-457-8771
  • Fax: 954-266-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0075684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: