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General NPI Number Information
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NPI Number | 1710907381
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Entity Type | Individual
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Provider Name | MARK A LAZAR DPM
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 720 FRY RD STE. A
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City | GREENWOOD
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State | IN
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Zip | 46142-2410
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Country | US
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Telephone | 317-881-0788
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Fax | 317-889-0775
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Provider Business Mailing Address
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Address Line | 6415 GREYRIDGE BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-3145
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Country | US
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Telephone | 317-788-7841
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Fax |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0700059-1
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License Number State | IN
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