Individual
MARIELLE BAZILE LAZARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
938 SAXON BLVD, SUITE 101-C, ORANGE CITY, FL 32763-8305
(386) 774-5485
(386) 775-0761
Mailing address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2321
(386) 258-8722
(386) 258-8659
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME87805
FL
207UN0901X
Nuclear Cardiology Physician
ME87805
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278018600
—
FL
01
—
88976
BC/BS
FL
Enumeration date
02/15/2007
Last updated
12/05/2017
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