Provider Demographics
NPI:1174537195
Name:LAZAROU, EMILY ELIZABETH (MD,RD,LD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ELIZABETH
Last Name:LAZAROU
Suffix:
Gender:F
Credentials:MD,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1044
Mailing Address - Country:US
Mailing Address - Phone:813-494-5922
Mailing Address - Fax:
Practice Address - Street 1:410 PIERCE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8646
Practice Address - Country:US
Practice Address - Phone:813-494-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN02022084P0800X
FLME901182084P0800X
MS209902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31826OtherBLUE CROSS BLUE SHIELD
FL281299100Medicaid
FLAK408ZMedicare PIN