MEDICARE: DR. AJAY LABROO M.D. FACC

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	207RC0000X	Cardiovascular Disease Physician	3303	WI
2	207RC0000X	Cardiovascular Disease Physician	036084756	IL
3	207RC0000X	Cardiovascular Disease Physician	ME105331	FL
4	207RI0011X	Interventional Cardiology Physician	3303	WI
5	207RI0011X	Interventional Cardiology Physician	ME105331	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036084756	OTHER	IL	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831199371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AJAY LABROO M.D. FACC

Provider Business Mailing Address
First Line	:	2428 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4304
Country	:	US
Telephone Number	:	850-215-6008
Fax Number	:	850-215-6020

Provider Business Practice Location Address
First Line	:	2428 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4304
Country	:	US
Telephone Number	:	850-215-6008
Fax Number	:	850-215-6020

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	09/21/2023

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