Healthcare Provider Details

I. General information

NPI: 1578569596
Provider Name (Legal Business Name): LAWRENCE G LAZAR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12085 W HILLSBOROUGH AVE
TAMPA FL
33635-9725
US

IV. Provider business mailing address

1145 19TH ST NW STE 409
WASHINGTON DC
20036-3701
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-5300
  • Fax: 813-738-9007
Mailing address:
  • Phone: 202-223-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO3786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: