Healthcare Provider Details

I. General information

NPI: 1336434729
Provider Name (Legal Business Name): JOHN LAZARUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 N COLUMBUS ST STE 100
LANCASTER OH
43130-8189
US

IV. Provider business mailing address

1153 E MAIN ST
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 740-689-4480
  • Fax: 740-277-7692
Mailing address:
  • Phone: 740-687-8636
  • Fax: 740-687-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.134503
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: