Healthcare Provider Details

I. General information

NPI: 1700491917
Provider Name (Legal Business Name): BRUNO COELHO DA ROCHA LAZARO MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 12/25/2025
Certification Date: 12/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE # 2346
STUART FL
34994-2346
US

IV. Provider business mailing address

2182 N BENSON RD
FAIRFIELD CT
06824-3134
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-5200
  • Fax:
Mailing address:
  • Phone: 434-825-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number312736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: