Individual
BONNIE A. LAZOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1110 OAKWOOD AVE, OAKWOOD, OH 45419
(419) 206-1249
(937) 567-0670
Mailing address
1110 OAKWOOD AVE, OAKWOOD, OH 45419-2911
(419) 206-1249
(937) 567-0670
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
38890
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000479105
ANTHEM BCBS
—
01
—
2746336000
PASSPORT ADVANTAGE
—
01
—
50011328
PASSPORT
—
05
—
64089535
—
KY
01
—
743176351A
HUMANA
—
01
—
P00343016
RAILROAD MEDICARE
—
Enumeration date
05/20/2006
Last updated
03/13/2019
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