Healthcare Provider Details

I. General information

NPI: 1669089223
Provider Name (Legal Business Name): LAZARUS 3D, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3513 NW MINK PL
CORVALLIS OR
97330-3729
US

IV. Provider business mailing address

3513 NW MINK PL
CORVALLIS OR
97330-3729
US

V. Phone/Fax

Practice location:
  • Phone: 541-760-1805
  • Fax:
Mailing address:
  • Phone: 541-760-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUES ZANEVELD
Title or Position: FOUNDER AND CEO
Credential: PH.D.
Phone: 541-760-1805