Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | E1649 | TX |
NPI | 1043251119 |
---|---|
Provider Name | Dr. Martin Lewis Lazar |
First Address | Dallas, TX 75230-2505 |
Second Address | Dallas, TX 75230-2505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C18218 | (02) |