Provider Demographics
NPI:1396729547
Name:LAZAGA, EDWARD JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSEPH
Last Name:LAZAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4812
Mailing Address - Country:US
Mailing Address - Phone:210-223-4140
Mailing Address - Fax:210-359-6640
Practice Address - Street 1:1222 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4812
Practice Address - Country:US
Practice Address - Phone:210-223-4140
Practice Address - Fax:210-359-6640
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7950207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1647927-01Medicaid
TX610405Medicare PIN
TXF97204Medicare UPIN