MEDICARE: DR. PRIMO NERY LARA JR. 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	207RH0003X	Hematology & Oncology Physician	A55072	CA

General Provider Information

NPI Number	:	1972585743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIMO NERY LARA JR. M.D.

Provider Business Mailing Address
First Line	:	3801 ASCADA PL
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-6764
Country	:	US
Telephone Number	:	916-734-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2279 45TH STREET
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2229
Country	:	US
Telephone Number	:	916-734-5959
Fax Number	:	916-703-5265

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	09/16/2019

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