Individual
FAUSTO J LAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55741 NATIONAL RD, BRIDGEPORT, OH 43912
(740) 635-4572
(740) 635-4575
Mailing address
55741 NATIONAL RD, BRIDGEPORT, OH 43912
(740) 635-4572
(740) 635-4575
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44336
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0456886
—
OH
Enumeration date
10/23/2006
Last updated
07/08/2007
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