Healthcare Provider Details

I. General information

NPI: 1619977378
Provider Name (Legal Business Name): LAWRENCE J HERBERHOLZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S BROAD ST
SCOTTSBORO AL
35768-2509
US

IV. Provider business mailing address

911 S BROAD ST
SCOTTSBORO AL
35768-2509
US

V. Phone/Fax

Practice location:
  • Phone: 256-259-0185
  • Fax: 256-259-0317
Mailing address:
  • Phone: 256-259-0185
  • Fax: 256-259-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23961
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: