MEDICARE: JESUS L. LIZARZABURU 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	207Q00000X	Family Medicine Physician	0101102625	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080007665	OTHER	VA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	318662	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1861490682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS L. LIZARZABURU M.D.

Provider Business Mailing Address
First Line	:	860 OMNI BLVD STE 101
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4430
Country	:	US
Telephone Number	:	757-232-8769
Fax Number	:	757-232-8875

Provider Business Practice Location Address
First Line	:	222 GRAFTON DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-2152
Country	:	US
Telephone Number	:	757-898-7737
Fax Number	:	757-898-8377

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	02/07/2020

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