Individual
JAIME ANDRES LAGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
98 WILLOW LN, SPARTANBURG, SC 29307-1357
(864) 585-5552
(864) 597-0179
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
2011-01327
NC
207K00000X
Allergy & Immunology Physician
30260
SC
207K00000X
Allergy & Immunology Physician
Primary
MD30260
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881684207
—
NC
05
—
302602
—
SC
01
—
AA23164292
MEDICARE PTAN
SC
01
—
NCT474A
MEDICARE PTAN
NC
Enumeration date
08/14/2007
Last updated
10/31/2023
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