Healthcare Provider Details

I. General information

NPI: 1003347410
Provider Name (Legal Business Name): EDUARDO JOSE LAZARO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 BEE RIDGE RD
SARASOTA FL
34233-5056
US

IV. Provider business mailing address

5731 BEE RIDGE RD
SARASOTA FL
34233-5056
US

V. Phone/Fax

Practice location:
  • Phone: 727-808-5824
  • Fax:
Mailing address:
  • Phone: 727-808-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME143773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: