| Entity Name: | DAVID W. LAZAN, MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 08 Sep 1998 (26 years ago) |
| Date of dissolution: | 20 Jul 2015 (10 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 20 Jul 2015 (10 years ago) |
| Document Number: | P98000078917 |
| FEI/EIN Number | 650859150 |
| Address: | 1600 36TH ST, SUITE B, VERO BEACH, FL, 32960 |
| Mail Address: | 1600 36TH ST, SUITE B, VERO BEACH, FL, 32960 |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013921899 | 2006-07-28 | 2009-12-22 | 1600 36TH STREET, SUITE B, VERO BEACH, FL, 32960, US | 1600 36TH STREET, SUITE B, VERO BEACH, FL, 32960, US | |||||||||||||||||||||||||||
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| Phone | +1 772-569-4464 |
| Fax | 7725695656 |
Authorized person
| Name | MR. DAVID WALTER LAZAN |
| Role | OWNER |
| Phone | 7725694464 |
Taxonomy
| Taxonomy Code | 208800000X - Urology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | GHI |
| Number | 9647005 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | DD8912 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAZAN DAVID W | Agent | 1600 36TH ST., VERO BEACH, FL, 32960 |
| Name | Role | Address |
|---|---|---|
| LAZAN DAVID W | President | 1600 36TH ST, STE B, VERO BEACH, FL, 32960 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2015-07-20 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-03-19 | 1600 36TH ST., SUITE B, VERO BEACH, FL 32960 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-04-10 | 1600 36TH ST, SUITE B, VERO BEACH, FL 32960 | No data |
| CHANGE OF MAILING ADDRESS | 2006-04-10 | 1600 36TH ST, SUITE B, VERO BEACH, FL 32960 | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2015-07-20 |
| ANNUAL REPORT | 2014-04-23 |
| ANNUAL REPORT | 2013-04-25 |
| ANNUAL REPORT | 2012-04-25 |
| ANNUAL REPORT | 2011-03-28 |
| ANNUAL REPORT | 2010-04-26 |
| ANNUAL REPORT | 2009-03-19 |
| ANNUAL REPORT | 2008-03-24 |
| ANNUAL REPORT | 2007-09-21 |
| ANNUAL REPORT | 2006-04-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
