MEDICARE: BONNIE A. LAZOR 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	38890	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00343016	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000479105	OTHER	ANTHEM BCBS
3	50011328	OTHER	PASSPORT
4	743176351A	OTHER	HUMANA
5	2746336000	OTHER	PASSPORT ADVANTAGE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548214059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE A. LAZOR M.D.

Provider Business Mailing Address
First Line	:	1110 OAKWOOD AVE
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45419-2911
Country	:	US
Telephone Number	:	419-206-1249
Fax Number	:	937-567-0670

Provider Business Practice Location Address
First Line	:	1110 OAKWOOD AVE
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45419
Country	:	US
Telephone Number	:	419-206-1249
Fax Number	:	937-567-0670

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	03/13/2019

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Directions to “ BONNIE A. LAZOR M.D.” Practice Location

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