Provider Demographics
NPI:1669661617
Name:LAGOR, KRISTEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:J
Last Name:LAGOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 S DALE MABRY HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4400
Mailing Address - Country:US
Mailing Address - Phone:813-548-7860
Mailing Address - Fax:813-605-6156
Practice Address - Street 1:711 S DALE MABRY HWY STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4445
Practice Address - Country:US
Practice Address - Phone:813-635-2106
Practice Address - Fax:813-605-6156
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME103313208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000913600Medicaid