Individual
LAZARO MESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3955 INDIAN RIVER BLVD STE 100, VERO BEACH, FL 32960-4845
(772) 569-2330
(772) 569-2630
Mailing address
3955 INDIAN RIVER BLVD STE 100, VERO BEACH, FL 32960-4845
(772) 569-2330
(772) 569-2630
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01092195A
IN
207X00000X
Orthopaedic Surgery Physician
Primary
ME169431
FL
207XS0106X
Orthopaedic Hand Surgery Physician
01092195A
IN
207XS0106X
Orthopaedic Hand Surgery Physician
ME169431
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01092195A
STATE LICENSE
IN
05
—
300085274
—
IN
Enumeration date
03/25/2019
Last updated
06/30/2025
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