Provider Demographics
NPI:1902167901
Name:LAZARUS, JENNY LYNN (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:LAZARUS
Suffix:
Gender:F
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:STONYFORD
Mailing Address - State:CA
Mailing Address - Zip Code:95979-0159
Mailing Address - Country:US
Mailing Address - Phone:916-678-0351
Mailing Address - Fax:
Practice Address - Street 1:130 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2826
Practice Address - Country:US
Practice Address - Phone:530-330-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043378208600000X
MI4301108934208D00000X
CAA168579208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery