Healthcare Provider Details

I. General information

NPI: 1598710311
Provider Name (Legal Business Name): IGOR LAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE PMB 404
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

PO BOX 932925
ATLANTA GA
31193-2925
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-4520
  • Fax: 404-265-3894
Mailing address:
  • Phone: 800-364-9216
  • Fax: 423-892-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number049973
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: