Healthcare Provider Details

I. General information

NPI: 1912196387
Provider Name (Legal Business Name): RICHARD W. LAZARO, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 MALL DR
LAS CRUCES NM
88011-8191
US

IV. Provider business mailing address

1131 MALL DR
LAS CRUCES NM
88011-8191
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-7676
  • Fax: 505-522-8121
Mailing address:
  • Phone: 505-522-7676
  • Fax: 505-522-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number83-236
License Number StateNM

VIII. Authorized Official

Name: RICHARD WAYNE LAZARO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-522-7676