Provider Demographics
NPI:1003813122
Name:LACAR, EDANILI SAGUN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDANILI
Middle Name:SAGUN
Last Name:LACAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 E BEAVER LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7921
Mailing Address - Country:US
Mailing Address - Phone:956-793-7888
Mailing Address - Fax:
Practice Address - Street 1:2153 E BEAVER LAKE DR SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-7921
Practice Address - Country:US
Practice Address - Phone:956-793-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1518208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124992206;124992205Medicaid
TXK0099021OtherDPS
TX124992207Medicaid
TXK1518OtherMEDICAL LICENSE
TXK1518OtherMEDICAL LICENSE
TX124992207Medicaid
TXK1518OtherMEDICAL LICENSE