Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | P6209 | TX |
Y | 207Q00000X | Family Doctor | P6209 | TX |
NPI | 1003102245 |
---|---|
Provider Name | Jonathan A Lazarini |
First Address | Fort Worth, TX 76123-4015 |
Second Address | Fort Worth, TX 76104-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 30/06/2015 |