Provider Demographics
NPI:1508894346
Name:LAGROTTERIA, DONNA RF (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:RF
Last Name:LAGROTTERIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:R
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 E ROUTT AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2006
Mailing Address - Country:US
Mailing Address - Phone:719-543-8717
Mailing Address - Fax:719-543-5340
Practice Address - Street 1:300 COLORADO
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2006
Practice Address - Country:US
Practice Address - Phone:719-543-8718
Practice Address - Fax:719-543-5340
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68102020Medicaid
COC468378Medicare PIN
CO68102020Medicaid
468378Medicare PIN