Healthcare Provider Details

I. General information

NPI: 1831687664
Provider Name (Legal Business Name): CHRISTOPHER LAZO JOSE R, CT, MR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

9589 COBBLEBROOK DR
PENSACOLA FL
32506-7992
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number535823
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number535823
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number535823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: