1770575011 NPI number — DR. MARSHALL R LAPLATA DO

Table of content: DR. MARSHALL R LAPLATA DO (NPI 1770575011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770575011 NPI number — DR. MARSHALL R LAPLATA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAPLATA
Provider First Name:
MARSHALL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770575011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 299
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37349-0299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-728-5607
Provider Business Mailing Address Fax Number:
931-728-8354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULLAHOMA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37388-2221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-455-2005
Provider Business Practice Location Address Fax Number:
931-455-4450
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  DO1201 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5635554 . This is a "AETNA PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 6357 . This is a "HEALTH 123" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2375737004 . This is a "CIGNA PLAN 139" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 980269 . This is a "AETNA HMO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2040222 . This is a "UHC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3064339 . This is a "B/S OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3304941 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2375737008 . This is a "CIGNA PLAN 110" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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