Provider Demographics
NPI:1437190188
Name:LAGESON, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:LAGESON
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 1:705 PLEASANT AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1440
Mailing Address - Country:US
Mailing Address - Phone:218-732-2800
Mailing Address - Fax:218-732-2857
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:218-732-2857
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31784208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11815OtherNDBS #
MN9F26LAOtherMNBS #
MN0402524OtherMEDICA #
MN10274OtherNDBS #
MN167225OtherUCARE #
MN904871OtherAMERICA'S PPO/ARAZ #
MNDA9041015677OtherPREFERRED ONE #
MNHP19534OtherHEALTHPARTNERS #
MN0402522OtherMEDICA #
MN0402523OtherMEDICA #
MNMN100004OtherLHS/BANNERHEALTH #
MNHP19534OtherHEALTHPARTNERS #
MN167225OtherUCARE #
MNE58763Medicare UPIN
MN119002262Medicare ID - Type UnspecifiedMN MEDICARE #
MNDA9041015677OtherPREFERRED ONE #
MN110075921Medicare ID - Type UnspecifiedRR MEDICARE #