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General NPI Number Information
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NPI Number | 1093529315
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Entity Type | Organization
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Legal Business Name | J. AGUSTIN LACSON M.D. INC
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 537 E CENTRAL AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3001
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Country | US
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Telephone | 863-320-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 537 E CENTRAL AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3001
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Country | US
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Telephone | 863-320-3530
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/ EMPLOYEE
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Name | JANICE CROSKERY
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Credential |
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Telephone | 863-385-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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