Provider Demographics
NPI:1093529315
Name:J. AGUSTIN LACSON M.D. INC
Entity type:Organization
Organization Name:J. AGUSTIN LACSON M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/ EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-385-6700
Mailing Address - Street 1:537 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3001
Mailing Address - Country:US
Mailing Address - Phone:863-320-3530
Mailing Address - Fax:
Practice Address - Street 1:537 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3001
Practice Address - Country:US
Practice Address - Phone:863-320-3530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J. AGUSTIN LACSON M.D. INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-06
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty