Provider Demographics
NPI:1174554893
Name:LAZAR, IRA LOUIS (MD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:LOUIS
Last Name:LAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 CLINT MOORE RD
Mailing Address - Street 2:STE 212
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496
Mailing Address - Country:US
Mailing Address - Phone:561-989-9070
Mailing Address - Fax:561-989-0255
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:STE 212
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496
Practice Address - Country:US
Practice Address - Phone:561-989-9070
Practice Address - Fax:561-989-0255
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL41886207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068748100Medicaid
FL94182AMedicare ID - Type UnspecifiedMEDICARE #
D63145Medicare UPIN