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General NPI Number Information
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NPI Number | 1972575223
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Entity Type | Individual
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Provider Name | RICHARD JOHN LAZAR MD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 1650 COCHRANE CIR
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City | FORT CARSON
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State | CO
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Zip | 80913-4613
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Country | US
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Telephone | 719-524-7175
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Fax | 719-524-7176
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Provider Business Mailing Address
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Address Line | 6 S BEECH RD
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City | PLAINS
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State | PA
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Zip | 18705-2204
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Country | US
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Telephone | 570-825-9576
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD022560E
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License Number State | PA
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