Provider Demographics
NPI:1609843135
Name:LAGARES-GARCIA, JORGE A (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:LAGARES-GARCIA
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:3510 N HIGHWAY 17 STE 110
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8228
Practice Address - Country:US
Practice Address - Phone:843-958-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33100208C00000X, 208C00000X
RIMD10845208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00908545OtherRAILROAD MC ID-RSFPN
SC331000Medicaid
RIH55720Medicare UPIN
RI029084436Medicare ID - Type UnspecifiedGROUP MEDICARE
SCP00908545OtherRAILROAD MC ID-RSFPN
RI007050165Medicare ID - Type UnspecifiedINDIVIDUAL