Healthcare Provider Details

I. General information

NPI: 1336324193
Provider Name (Legal Business Name): PATRICK JACQUES LAGUERRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2007
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MEDICAL PARK ROAD SUITE 108
MOORESVILLE NC
28117-8529
US

IV. Provider business mailing address

146 MEDICAL PARK ROAD SUITE 108
MOORESVILLE NC
28117-8529
US

V. Phone/Fax

Practice location:
  • Phone: 704-662-0877
  • Fax: 704-662-0875
Mailing address:
  • Phone: 704-662-0877
  • Fax: 704-662-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number127572
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number127572
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2009-00660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: