Basic Information
| Provider Information | |||||||||
| NPI: | 1518050608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAZARUS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 6421 MCCART AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761334702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172637500 | ||||||||
| FaxNumber: | 8174234140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | E7157 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | E7157 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 134642104 | 05 | TX | MEDICAID | 134642105 | 05 | TX | MEDICAID | 138412505 | 05 | TX | MEDICAID | 1392539 | 01 | TX | UHC PIN | OTHER | 10028668 | 01 | TX | AMERIGROUP PIN | OTHER | 138412507 | 05 | TX | MEDICAID | 413475 | 01 | TX | PHCS PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 113052 | 01 | TX | SUPERIOR PIN | OTHER | 1640382 | 01 | TX | FIRSTHEALTH PIN | OTHER | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 82V082 | 01 | TX | BCBSTX IND PIN | OTHER | 9239598 | 01 | TX | CIGNA PIN | OTHER | 117492100 | 01 | TX | FIRSTCARE PIN | OTHER | 4391266 | 01 | TX | AETNA PIN | OTHER |