Individual
DR. LARRY RIVERA LAZARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1721 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
(810) 692-4030
(616) 222-0284
Mailing address
1721 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
(810) 692-4030
(616) 222-0284
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301069069
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4786502
—
MI
01
—
LL069069
BLUE CROSS PIN
MI
Enumeration date
12/27/2005
Last updated
05/30/2013
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