Basic Information
| Provider Information | |||||||||
| NPI: | 1023033073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAGRIMAS | ||||||||
| FirstName: | FERNANDO | ||||||||
| MiddleName: | CARDENAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1117 CHEROKEE CIR | ||||||||
| Address2: | |||||||||
| City: | TIPTONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380791620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762759208 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 710 CARL PERKINS PKWY | ||||||||
| Address2: | |||||||||
| City: | TIPTONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380791678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312536690 | ||||||||
| FaxNumber: | 7312536692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 12/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101047198 | VA | N | Other Service Providers | Specialist | 207Q00000X | 54098 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | Q023518 | 05 | TN | MEDICAID | 010238544 | 05 | VA | MEDICAID |