Healthcare Provider Details

I. General information

NPI: 1285787465
Provider Name (Legal Business Name): ERNEST ANASTASIOS LAZOS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 EVESHAM RD SUITE 507
VOORHEES NJ
08043
US

IV. Provider business mailing address

2301 EVESHAM RD SUITE 507
VOORHEES NJ
08043
US

V. Phone/Fax

Practice location:
  • Phone: 856-772-2979
  • Fax: 856-770-1192
Mailing address:
  • Phone: 856-772-2979
  • Fax: 856-770-1192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD01805
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: