Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 008132 | GA |
NPI | 1235248170 |
---|---|
Provider Name | Dr. Robert M Lazerson |
First Address | Marietta, GA 30062-4996 |
Second Address | Marietta, GA 30062-4996 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |