Provider Demographics
NPI:1124531686
Name:LAGDOB MEDICAL, PLLC
Entity type:Organization
Organization Name:LAGDOB MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDMS NPI COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-2801
Mailing Address - Street 1:5600 W LOVERS LN STE 116
Mailing Address - Street 2:284
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-4360
Mailing Address - Country:US
Mailing Address - Phone:469-754-0993
Mailing Address - Fax:
Practice Address - Street 1:5600 W LOVERS LN STE 116
Practice Address - Street 2:284
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-4360
Practice Address - Country:US
Practice Address - Phone:469-754-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty