MEDICARE: EUGENE A. LAMAZOR, M.D., INC.

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	208000000X	Pediatrics Physician	G18252	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G18252	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1568470144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE A. LAMAZOR, M.D., INC.

Provider Business Mailing Address
First Line	:	4725 ENTERPRISE WAY
Second Line	:	SUITE 1
City	:	MODESTO
State	:	CA
Zip	:	95356-8967
Country	:	US
Telephone Number	:	209-543-6279
Fax Number	:	209-543-6280

Provider Business Practice Location Address
First Line	:	1108 WARD AVE
Second Line	:	BLDG. A SUITE 1
City	:	PATTERSON
State	:	CA
Zip	:	95363-8529
Country	:	US
Telephone Number	:	209-892-9100
Fax Number	:	209-892-0831

Authorized Official
Title or Position	:	AUTHORIZED REP
Name	:	MARGO ARNOLD
Credential	:
Telephone Number	:	209-892-9100

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	08/22/2020

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