MEDICARE: DR. JACQUELYN MICHELE LAGRONE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	P9625	TX
2	2084P0804X	Child & Adolescent Psychiatry Physician	P9625	TX

General Provider Information

NPI Number	:	1801189162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELYN MICHELE LAGRONE MD

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-8589
Country	:	US
Telephone Number	:	214-456-1383
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-8589
Country	:	US
Telephone Number	:	214-456-1383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	10/12/2017

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