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Individual

DEBRA S. LAZZARO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2708 GUILFORD ST, HUNTINGTON, IN 46750-9701
(260) 355-3900
(260) 355-3079
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-7875
(260) 373-9705

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01041253A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000368345
ANTHEM
IN
05
100095880
IN
01
3937240023
MEDICARE DMEPOS
IN
01
5223
PHYSICIANS HEALTH PLAN
IN
01
P00315302
RAILROAD MEDICARE
IN
Enumeration date
12/15/2005
Last updated
09/23/2013
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