Provider Demographics
NPI:1790766996
Name:LAGUARDIA, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:LAGUARDIA
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 1:1723 BROADWAY ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4566
Mailing Address - Country:US
Mailing Address - Phone:573-331-7840
Mailing Address - Fax:573-331-7849
Practice Address - Street 1:1723 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4566
Practice Address - Country:US
Practice Address - Phone:573-331-7840
Practice Address - Fax:573-331-7849
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360937272084N0400X
IN01066417A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00834681OtherRAILROAD MEDICARE
IL036093727Medicaid
INP00739574OtherRAILROAD MEDICARE
INP00834681OtherRAILROAD MEDICARE
ILL82253Medicare PIN
IL256510Medicare PIN
IL036093727Medicaid
INP00739574OtherRAILROAD MEDICARE
G54073Medicare UPIN
IN192770A9Medicare PIN
IN187310FMedicare PIN