Healthcare Provider Details

I. General information

NPI: 1912968967
Provider Name (Legal Business Name): SPIROS P LAZOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25A JUNE ST STE 111
SANFORD ME
04073
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-490-7998
  • Fax:
Mailing address:
  • Phone: 207-459-7195
  • Fax: 207-459-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number014714
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: