Healthcare Provider Details

I. General information

NPI: 1881686079
Provider Name (Legal Business Name): ANDREW L. LAZIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST SUITE 306
SARASOTA FL
34239-2943
US

IV. Provider business mailing address

1921 WALDEMERE ST SUITE 306
SARASOTA FL
34239-2943
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8722
  • Fax: 941-917-8727
Mailing address:
  • Phone: 941-917-8722
  • Fax: 941-917-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME58678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: