Provider Demographics
NPI:1699088104
Name:FOUGERE, LAZAU P (MD)
Entity type:Individual
Prefix:
First Name:LAZAU
Middle Name:P
Last Name:FOUGERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAZAU
Other - Middle Name:P
Other - Last Name:FOUGERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:507 W ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7136
Mailing Address - Country:US
Mailing Address - Phone:813-754-3504
Mailing Address - Fax:813-752-6863
Practice Address - Street 1:5503 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5419
Practice Address - Country:US
Practice Address - Phone:813-200-7717
Practice Address - Fax:813-985-8500
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine