Basic Information
| Provider Information | |||||||||
| NPI: | 1063452548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAZARUS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | DARLENE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11840 FM 1960 RD W | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770653840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8329127044 | ||||||||
| FaxNumber: | 8329127033 | ||||||||
| Practice Location | |||||||||
| Address1: | 12015 LOUETTA RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770701148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816642152 | ||||||||
| FaxNumber: | 2816642152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | M1868 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 208000000X | M1868 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 178813501 | 05 | TX | MEDICAID |