Provider Demographics
NPI:1154427375
Name:LANZKOWSKY, DAVID R
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:LANZKOWSKY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4454 N DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-5286
Mailing Address - Country:US
Mailing Address - Phone:702-507-0996
Mailing Address - Fax:702-507-0992
Practice Address - Street 1:4454 N DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-5286
Practice Address - Country:US
Practice Address - Phone:702-507-0996
Practice Address - Fax:702-507-0992
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6468207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F46489Medicare UPIN