Provider Demographics
NPI:1023033073
Name:LAGRIMAS, FERNANDO CARDENAS (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:CARDENAS
Last Name:LAGRIMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 CHEROKEE CIR
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-1620
Mailing Address - Country:US
Mailing Address - Phone:276-275-9208
Mailing Address - Fax:
Practice Address - Street 1:710 CARL PERKINS PKWY
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1678
Practice Address - Country:US
Practice Address - Phone:731-253-6690
Practice Address - Fax:731-253-6692
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047198174400000X
TN54098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ023518Medicaid
VA010238544Medicaid
TN103I080888Medicare PIN
VAB39603Medicare UPIN