Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401005734 | VA |
Y | 213EG0000X | General Practice | 0401005734 | VA |
NPI | 1003036211 |
---|---|
Provider Name | Dr. Dale Lazar |
First Address | Kilmarnock, VA 22482-0730 |
Second Address | Kilmarnock, VA 22482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2007 |
Last Update Date | 17/03/2011 |