Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 79829 | MA |
N | 207YS0123X | Facial Plastic Surgeon | 79829 | MA |
NPI | 1821089921 |
---|---|
Provider Name | Dr. John B. Lazor |
First Address | Quincy, MA 02169-0960 |
Second Address | Quincy, MA 02169-0908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 26/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3135276 | (05) | MA |
F98929 | (02) | MA |