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General NPI Number Information
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NPI Number | 1265751424
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Entity Type | Individual
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Provider Name | PAUL JAMES LANZON P.A.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 05/28/2016
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Provider Practice Location Address
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Address Line | 3015 S STATE RD
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City | IONIA
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State | MI
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Zip | 48846-9416
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Country | US
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Telephone | 616-522-9110
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Fax | 616-522-9114
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Provider Business Mailing Address
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Address Line | 3015 S STATE RD
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City | IONIA
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State | MI
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Zip | 48846-8777
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Country | US
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Telephone | 616-522-9110
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Fax | 616-522-9114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601001317
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License Number State | MI
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