Individual
NICHOLAS A. LAZZARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
190 E BANNOCK, BOISE, ID 83712
(208) 381-2094
(208) 381-1791
Mailing address
115 W MAIN STREET, SUITE 202, BOISE, ID 83702
(208) 433-9466
(208) 433-1149
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
4301082251
MI
2085R0202X
Diagnostic Radiology Physician
Primary
M-11001
ID
Other
Enumeration date
07/26/2007
Last updated
07/08/2010
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