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General NPI Number Information
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NPI Number | 1780727172
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Entity Type | Organization
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Legal Business Name | LAZENBY & HEATH MD'S PA
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 1109 US HIGHWAY 19
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City | HOLIDAY
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State | FL
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Zip | 34691-5638
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Country | US
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Telephone | 727-934-5705
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Fax | 727-937-3756
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Provider Business Mailing Address
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Address Line | 1109 US HIGHWAY 19
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City | HOLIDAY
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State | FL
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Zip | 34691-5638
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Country | US
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Telephone | 727-934-5705
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Fax | 727-937-3756
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Authorized Official
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Title or Position | CEO
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Name | DIANA HEATHER HEATH
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Credential | M.D.
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Telephone | 727-934-5705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 1291
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License Number State | FL
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