Provider Demographics
NPI:1043086044
Name:FRONTIER DIRECT CARE RAYMONDVILLE
Entity type:Organization
Organization Name:FRONTIER DIRECT CARE RAYMONDVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZOPINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-545-5224
Mailing Address - Street 1:119 W VAN BUREN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-6400
Mailing Address - Country:US
Mailing Address - Phone:956-983-9272
Mailing Address - Fax:956-275-2000
Practice Address - Street 1:100 N US HIGHWAY 77 STE K
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4010
Practice Address - Country:US
Practice Address - Phone:956-394-0968
Practice Address - Fax:956-394-1137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONTIER STAFFING PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty