Provider Demographics
NPI:1629206891
Name:LAGOUROS, EVAN PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:PETER
Last Name:LAGOUROS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8921 N WOOD SAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-3869
Mailing Address - Fax:309-243-7918
Practice Address - Street 1:8921 N WOOD SAGE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7822
Practice Address - Country:US
Practice Address - Phone:309-243-3869
Practice Address - Fax:309-243-7918
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2020-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036135865207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology