Healthcare Provider Details

I. General information

NPI: 1407837289
Provider Name (Legal Business Name): RICHARD LAZAROFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11630 STUDT AVE
SAINT LOUIS MO
63141-7016
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-7337
  • Fax: 314-851-4476
Mailing address:
  • Phone: 314-567-7337
  • Fax: 314-851-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR3A04
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: