Healthcare Provider Details

I. General information

NPI: 1922684927
Provider Name (Legal Business Name): JOSEPH LAZARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N LEE AVE STE 305
OKLAHOMA CITY OK
73103-2620
US

IV. Provider business mailing address

1111 N LEE AVE STE 305
OKLAHOMA CITY OK
73103-2620
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-4978
  • Fax: 405-772-4430
Mailing address:
  • Phone: 405-272-4978
  • Fax: 405-772-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number44125
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44125
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: