Healthcare Provider Details

I. General information

NPI: 1619939816
Provider Name (Legal Business Name): LISBETH M LAZARON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE SUITE 235
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-3238
  • Fax: 513-585-3254
Mailing address:
  • Phone: 513-585-5502
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35059221L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: