Provider Demographics
NPI:1740239292
Name:LAGRASSO, JEFFREY RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RAYMOND
Last Name:LAGRASSO
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 1:600 HERITAGE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3000
Mailing Address - Country:US
Mailing Address - Phone:561-624-0900
Mailing Address - Fax:561-627-3006
Practice Address - Street 1:600 HERITAGE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3000
Practice Address - Country:US
Practice Address - Phone:561-624-0900
Practice Address - Fax:561-627-3006
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1022552086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I51961Medicare UPIN
I519611955Medicare ID - Type Unspecified