Provider Demographics
NPI:1013179506
Name:ROBERT & DAWN LAGONE DPM PC
Entity Type:Organization
Organization Name:ROBERT & DAWN LAGONE DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TELETHA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MAXSON
Authorized Official - Suffix:
Authorized Official - Credentials:INTERNET SECURITY
Authorized Official - Phone:563-263-0000
Mailing Address - Street 1:1020 SPRUCE HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2356
Mailing Address - Country:US
Mailing Address - Phone:563-359-3000
Mailing Address - Fax:563-359-1611
Practice Address - Street 1:1020 SPRUCE HILLS DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2356
Practice Address - Country:US
Practice Address - Phone:563-359-3000
Practice Address - Fax:563-359-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00542213E00000X
IA00484213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0444695Medicaid
IACN8847Medicare PIN
IAI8750Medicare PIN
IA480025020Medicare PIN
IA0349660002Medicare NSC
IA480025261Medicare PIN