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1326022997

NPI Code Detail

MEDICARE: DR. PHILIP CAREY LAGESSE MD

MEDICARE: DR. PHILIP CAREY LAGESSE 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	208000000X	Pediatrics Physician	MD16611	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	R0000WFBTV	OTHER	OR	MEDICARE GROUP PIN NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1407812365	OTHER	OR	NBMC NPI NUMBER-GROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326022997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP CAREY LAGESSE MD

Provider Business Mailing Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-266-4534

Provider Business Practice Location Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-266-4534

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	03/22/2010

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Directions to “ DR. PHILIP CAREY LAGESSE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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