Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 32941 | MA |
N | 207QA0505X | Family Doctor - Adult Medicine | 32941 | MA |
NPI | 1154324390 |
---|---|
Provider Name | Paul A Lagac |
First Address | Southwick, MA 01077-9690 |
Second Address | Southwick, MA 01077-9690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2006979 | (05) | MA |
A55599 | (02) |