Individual
BRUCE LAZARUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 BREWSTER ST, DEPT. OF PHYSICAL MEDICINE / REHABILITATION, PAWTUCKET, RI 02860-4400
(401) 729-2326
(401) 729-2243
Mailing address
111 BREWSTER ST, DEPT. OF PHYSICAL MEDICINE / REHABILITATION, PAWTUCKET, RI 02860-4400
(401) 729-2326
(401) 729-2243
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD07243
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007057387
MEDICARE PTAN
RI
05
—
9006444
—
RI
Enumeration date
03/02/2006
Last updated
05/17/2010
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