Healthcare Provider Details

I. General information

NPI: 1477871549
Provider Name (Legal Business Name): MR. LEE H. LAZERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6231 NW 75TH WAY
PARKLAND FL
33067-1250
US

IV. Provider business mailing address

6231 NW 75TH WAY
PARKLAND FL
33067-1250
US

V. Phone/Fax

Practice location:
  • Phone: 954-464-6134
  • Fax: 866-275-4496
Mailing address:
  • Phone: 954-464-6134
  • Fax: 866-275-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: