Individual
DR. THOMAS L LAZOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 458-3640
(260) 479-1819
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 458-3640
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01040711A
IN
208VP0000X
Pain Medicine Physician
01040711A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200089810A
—
IN
01
—
P00390615
RR MEDICARE
IN
Enumeration date
05/24/2005
Last updated
02/07/2024
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