MEDICARE: LUIS PAGOAGA M.D.

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	207Q00000X	Family Medicine Physician	29003	TN

General Provider Information

NPI Number	:	1225032956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS PAGOAGA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38302-0400
Country	:	US
Telephone Number	:	731-423-8697
Fax Number	:	731-422-5743

Provider Business Practice Location Address
First Line	:	2859 HIGHWAY 45 BYP
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3618
Country	:	US
Telephone Number	:	731-660-8360
Fax Number	:	731-660-8377

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/28/2013

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