Active NPI
Jack Lazerson, M.D.
- Pediatric Hematology & Oncology Physician
- Las Vegas, NV
National Provider Identifier
1174501985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Hematology & Oncology Physician
- License
- 5408
- Practice address
- 1524 Pinto LN
Las Vegas, NV 89106-4195 - Phone
- (702) 671-2231
- Fax
- (702) 671-2233
- NPI assigned
- Jan 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5408 | NV | |
| Pediatric Hematology & Oncology Physician | 2080P0207X | 5408 | NV | Primary |
Addresses
Primary practice location
1524 Pinto LN
Las Vegas, NV 89106-4195
Mailing address
2040 W Charleston Blvd
202-A
Las Vegas, NV 89102-2227
Phone (702) 671-2355
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002019718 | Medicaid | NV | |
| CS04078 | Other | NV | STATE PHARMACY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5408 | NV | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1174501985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2040 W CHARLESTON BLVD",
"address_2": "202-A",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891022227",
"telephone_number": "702-671-2355",
"fax_number": "702-382-5388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1524 PINTO LN",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891064195",
"telephone_number": "702-671-2231",
"fax_number": "702-671-2233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAZERSON",
"first_name": "JACK",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-03",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NV",
"license": "5408",
"primary": false
},
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "NV",
"license": "5408",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002019718",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE PHARMACY",
"identifier": "CS04078",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.