Healthcare Provider Details

I. General information

NPI: 1083685531
Provider Name (Legal Business Name): LAWRENCE W. LAZARUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DR STE 901B
SANTA FE NM
87505-5569
US

IV. Provider business mailing address

PO BOX 1968
SANTA FE NM
87504-1968
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-2302
  • Fax: 505-982-4777
Mailing address:
  • Phone: 505-820-2302
  • Fax: 505-982-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2001-62
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: