Provider Demographics
NPI:1619931821
Name:J. AGUSTIN LACSON M.D. INC
Entity Type:Organization
Organization Name:J. AGUSTIN LACSON M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J. AGUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-385-6700
Mailing Address - Street 1:PO BOX 7514
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-0109
Mailing Address - Country:US
Mailing Address - Phone:863-385-6700
Mailing Address - Fax:
Practice Address - Street 1:3300 US 27 S
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9701
Practice Address - Country:US
Practice Address - Phone:863-385-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072358207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110241195OtherRAILROAD MEDICARE
FLK3795Medicare PIN