Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | M1868 | TX |
N | 2080A0000X | Adolescent Medicine | M1868 | TX |
NPI | 1063452548 |
---|---|
Provider Name | Dr. Kimberly Darlene Lazarus |
First Address | Houston, TX 77065-3840 |
Second Address | Houston, TX 77070-1148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 14/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
178813501 | (05) | TX |