Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | R5421 | TX |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | R5421 | TX |
NPI | 1891094306 |
---|---|
Provider Name | Dr. Michael Timothy Lago |
First Address | Edinburg, TX 78539-6681 |
Second Address | Edinburg, TX 78539-9140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2011 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3788572-03 | (05) | TX |
H08LK12801 | BCBS (01) | TX |