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General NPI Number Information
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NPI Number | 1619931821
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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 | 04/14/2006
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 3300 US 27 S
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City | AVON PARK
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State | FL
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Zip | 33825-9701
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Country | US
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Telephone | 863-385-6700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7514
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City | SEBRING
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State | FL
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Zip | 33872-0109
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Country | US
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Telephone | 863-385-6700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | J. AGUSTIN LACSON
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Credential | M.D.
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Telephone | 863-835-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME0072358
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License Number State | FL
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