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NPI Code Detail

MEDICARE: LAWRENCE J HERBERHULZ MD, PC

MEDICARE: LAWRENCE J HERBERHULZ MD, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151524140OTHERALBLUE CROSS

General Provider Information

NPI Number : 1336331594
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAWRENCE J HERBERHULZ MD, PC
Provider Business Mailing Address
First Line : 911 S BROAD ST
Second Line :
City : SCOTTSBORO
State : AL
Zip : 35768-2509
Country : US
Telephone Number : 256-259-0185
Fax Number : 256-259-0317
Provider Business Practice Location Address
First Line : 911 S BROAD ST
Second Line :
City : SCOTTSBORO
State : AL
Zip : 35768-2509
Country : US
Telephone Number : 256-259-0185
Fax Number : 256-259-0317
Authorized Official
Title or Position : PRESIDENT AND OWNER
Name : LAWRENCE J HERBERHULZ
Credential : MD
Telephone Number : 256-259-0185
Provider Enumeration Date : 08/13/2007
Last Update Date : 08/29/2007

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