Healthcare Provider Details

I. General information

NPI: 1467443572
Provider Name (Legal Business Name): PATRICK WALTER LAPPERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1874 BELTLINE RD SW SUITE 120
DECATUR AL
35601-5514
US

IV. Provider business mailing address

1874 BELTLINE RD SW SUITE 120
DECATUR AL
35601-5514
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-5585
  • Fax: 256-350-8415
Mailing address:
  • Phone: 256-355-5585
  • Fax: 256-350-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number00026634
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: