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Organization

LAZO FAMILY MEDICINE INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
FAUSTO J LAZO MD (MD PRESIDENT)
(740) 635-4572
Entity
Organization

Contact information

Practice address
55741 NATIONAL RD, BRIDGEPORT, OH 43912
(740) 635-4572
(740) 635-4575
Mailing address
55741 NATIONAL RD, BRIDGEPORT, OH 43912-1528
(740) 635-4572
(740) 635-4575

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0458339
OH
05
3810016451
WV
Enumeration date
10/23/2006
Last updated
03/20/2014
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