Individual
J. AGUSTIN LACSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3300 US 27 S, AVON PARK, FL 33825-9701
(863) 385-6700
Mailing address
PO BOX 7514, SEBRING, FL 33872-0109
(863) 385-6700
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
ME0072358
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024129700
—
FL
01
—
110241195
RAILROAD MEDICARE
FL
01
—
44661
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/14/2006
Last updated
09/08/2022
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