1306003512 NPI number — LAWRENCE WALTER LIBENGOOD III IDC

Table of content: LAWRENCE WALTER LIBENGOOD III IDC (NPI 1306003512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306003512 NPI number — LAWRENCE WALTER LIBENGOOD III IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIBENGOOD
Provider First Name:
LAWRENCE
Provider Middle Name:
WALTER
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
IDC
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:
1306003512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2D LAAD BN DET A
Provider Second Line Business Mailing Address:
H&S BATTERY UNIT 78087
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09509-8087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-342-2177
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2D LAAD BN DET A
Provider Second Line Business Practice Location Address:
UNIT 78087 H&S BATTERY
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09509-8087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-342-2177
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2008

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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