Healthcare Provider Details

I. General information

NPI: 1346745585
Provider Name (Legal Business Name): PETER LAZARZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 NE ELLISON DR
LEES SUMMIT MO
64064-1939
US

IV. Provider business mailing address

3721 NE ELLISON DR
LEES SUMMIT MO
64064-1939
US

V. Phone/Fax

Practice location:
  • Phone: 816-588-2169
  • Fax:
Mailing address:
  • Phone: 816-588-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022006855
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: