Healthcare Provider Details

I. General information

NPI: 1255469805
Provider Name (Legal Business Name): LAZENBY & HEATH MD'S PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 E BAY DR
LARGO FL
33771-2469
US

IV. Provider business mailing address

2770 E BAY DR
LARGO FL
33771-2469
US

V. Phone/Fax

Practice location:
  • Phone: 727-530-1426
  • Fax: 727-535-9280
Mailing address:
  • Phone: 727-530-1426
  • Fax: 727-535-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1291
License Number StateFL

VIII. Authorized Official

Name: DIANA HEATHER HEATH
Title or Position: CEO OWNER
Credential: MD
Phone: 727-530-1426