Provider Demographics
NPI:1598757098
Name:LAGMAN, SERGIO M (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:M
Last Name:LAGMAN
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 1:159 N. 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-0484
Mailing Address - Country:US
Mailing Address - Phone:904-259-3151
Mailing Address - Fax:904-259-4675
Practice Address - Street 1:159 N. 3RD STREET
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-0484
Practice Address - Country:US
Practice Address - Phone:904-259-3151
Practice Address - Fax:904-259-4675
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME324572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037749000Medicaid
FLD52588Medicare UPIN
FL15447Medicare ID - Type Unspecified