Individual
MICHAEL J LAZAR JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1140 SONOMA AVE, STE 1A, SANTA ROSA, CA 95405-4817
(707) 546-5553
(707) 546-0725
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 575-6049
(707) 546-0725
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
C40958
CA
2088P0231X
Pediatric Urology Physician
C40958
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C409580
BS OF CALIFORNIA
CA
05
—
1376505180
—
CA
01
—
P00638732
RAILROAD MEDICARE
—
Enumeration date
04/05/2006
Last updated
02/07/2012
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