Provider Demographics
NPI:1215206560
Name:JOSEPH A LAGUNA MD PA
Entity Type:Organization
Organization Name:JOSEPH A LAGUNA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAGUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-797-3798
Mailing Address - Street 1:2725 PARK DR STE 5
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1023
Mailing Address - Country:US
Mailing Address - Phone:727-797-3798
Mailing Address - Fax:727-791-6800
Practice Address - Street 1:2725 PARK DR STE 5
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1023
Practice Address - Country:US
Practice Address - Phone:727-797-3798
Practice Address - Fax:727-791-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069064300Medicaid
FLD58690Medicare UPIN
FL069064300Medicaid
FL110037741Medicare Oscar/Certification