MEDICARE: DR. JOHN L LAUBENTHAL M.D.

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
1	2084P0800X	Psychiatry Physician	ME79504	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61596, 38589	OTHER	FL	BC OF FL: INDIVID AND GRP
2	ME79504	OTHER	FL	FLORIDA LICENSE NUMBER

General Provider Information

NPI Number	:	1528064458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN L LAUBENTHAL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 28480
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32411-8480
Country	:	US
Telephone Number	:	850-249-7400
Fax Number	:	850-249-7424

Provider Business Practice Location Address
First Line	:	2226 THOMAS DR
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-5814
Country	:	US
Telephone Number	:	850-249-7400
Fax Number	:	850-249-7424

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/15/2012

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