Healthcare Provider Details

I. General information

NPI: 1144288069
Provider Name (Legal Business Name): ANTHONY L LAZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S GEAR AVE SUITE 109
WEST BURLINGTON IA
52655-1682
US

IV. Provider business mailing address

1223 S GEAR AVE SUITE 109
WEST BURLINGTON IA
52655-1682
US

V. Phone/Fax

Practice location:
  • Phone: 319-754-4004
  • Fax: 319-753-5498
Mailing address:
  • Phone: 319-754-4004
  • Fax: 319-753-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number23402
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: