Provider Demographics
NPI:1548486053
Name:LAZARTE, HARRY A (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:A
Last Name:LAZARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2131 S BONITO WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1659
Mailing Address - Country:US
Mailing Address - Phone:877-801-2244
Mailing Address - Fax:208-489-9518
Practice Address - Street 1:3911 AVENUE B STE 2100
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-630-2920
Practice Address - Fax:308-630-1890
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE5296207R00000X
ARE-5577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5H154OtherAR BCBS
AR5H154Medicare PIN
WYW24653Medicare PIN