Basic Information
| Provider Information | |||||||||
| NPI: | 1568470144 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EUGENE A. LAMAZOR, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4725 ENTERPRISE WAY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953568967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095436279 | ||||||||
| FaxNumber: | 2095436280 | ||||||||
| Practice Location | |||||||||
| Address1: | 1108 WARD AVE | ||||||||
| Address2: | BLDG. A SUITE 1 | ||||||||
| City: | PATTERSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953638529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098929100 | ||||||||
| FaxNumber: | 2098920831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ARNOLD | ||||||||
| AuthorizedOfficialFirstName: | MARGO | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED REP | ||||||||
| AuthorizedOfficialTelephone: | 2098929100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G18252 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | G18252 | 01 | CA | MEDICAL LICENSE | OTHER |