Provider Demographics
NPI:1144219445
Name:LAGO, CHARLES PETER SR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PETER
Last Name:LAGO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15466
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33318-5466
Mailing Address - Country:US
Mailing Address - Phone:954-236-5444
Mailing Address - Fax:954-236-5422
Practice Address - Street 1:350 N PINE ISLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1849
Practice Address - Country:US
Practice Address - Phone:954-236-5444
Practice Address - Fax:954-236-5422
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME66163208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26971OtherBLUE CROSS BLUE SHIELD
FL378125900OtherTCA
FL378125900Medicaid
FL3392686OtherAETNA HMO
FL1002966OtherCARE PLUS
FL5578459OtherAETNA PPO
FL201272OtherAMERI GROUP
FL1380688OtherUNITED HEALTHCARE
FL202325OtherAVMED
FL5334OtherN H P
FL26971YMedicare PIN