Healthcare Provider Details

I. General information

NPI: 1912165226
Provider Name (Legal Business Name): BORIS LAZAREV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34503 9TH AVE S STE 100
FEDERAL WAY WA
98003-8727
US

IV. Provider business mailing address

34503 9TH AVE S STE 100
FEDERAL WAY WA
98003-8727
US

V. Phone/Fax

Practice location:
  • Phone: 253-261-0519
  • Fax: 253-835-8000
Mailing address:
  • Phone: 253-261-0519
  • Fax: 253-835-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA109320
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD151159
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number246945
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60613516
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: