Provider Demographics
NPI:1215127311
Name:LAZATIN, LANCE J (MD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:J
Last Name:LAZATIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6055 W 46TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-1811
Mailing Address - Country:US
Mailing Address - Phone:303-423-8017
Mailing Address - Fax:720-639-6894
Practice Address - Street 1:6055 W 46TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-1811
Practice Address - Country:US
Practice Address - Phone:303-423-8017
Practice Address - Fax:720-639-6894
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO50291208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000154721Medicaid
CO63008564Medicaid
MA000418801Medicare PIN