MEDICARE: DR. GERALD MARTIN LAZAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	174906-1205	UT

General Provider Information

NPI Number	:	1003883349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD MARTIN LAZAR M.D.

Provider Business Mailing Address
First Line	:	4187 NEPTUNE DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3343
Country	:	US
Telephone Number	:	801-272-1777
Fax Number	:	801-322-3890

Provider Business Practice Location Address
First Line	:	2005 E 2700 S
Second Line	:	SUITE 180
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1700
Country	:	US
Telephone Number	:	801-746-2297
Fax Number	:	801-322-3890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/17/2007

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