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General NPI Number Information
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NPI Number | 1669089223
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Entity Type | Organization
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Legal Business Name | LAZARUS 3D, INC.
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 3513 NW MINK PL
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City | CORVALLIS
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State | OR
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Zip | 97330-3729
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Country | US
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Telephone | 541-760-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 3513 NW MINK PL
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City | CORVALLIS
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State | OR
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Zip | 97330-3729
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Country | US
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Telephone | 541-760-1805
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND CEO
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Name | DR. JACQUES ZANEVELD
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Credential | PH.D.
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Telephone | 541-760-1805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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