Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A134398 | CA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 39882 | SC |
NPI | 1306162375 |
---|---|
Provider Name | David Evan Lazarus |
First Address | Greenville, SC 29615-4545 |
Second Address | Greenville, SC 29605-5608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 11/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
398821 | (05) | SC |