Healthcare Provider Details

I. General information

NPI: 1326010745
Provider Name (Legal Business Name): STEPHEN LAZOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 SAN JOSE PARK DR
JACKSONVILLE FL
32217-4612
US

IV. Provider business mailing address

PO BOX 40815
JACKSONVILLE FL
32203-0815
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-3530
  • Fax: 904-737-1548
Mailing address:
  • Phone: 904-737-7668
  • Fax: 904-737-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME25404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: