Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 5408 | NV |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 5408 | NV |
NPI | 1174501985 |
---|---|
Provider Name | Jack Lazerson |
First Address | Las Vegas, NV 89102-2227 |
Second Address | Las Vegas, NV 89106-4195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 29/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002019718 | (05) | NV |
A57995 | (02) | NV |
BL0765783 | DEA (01) | NE |
CS04078 | STATE PHARMACY (01) | NV |