Healthcare Provider Details

I. General information

NPI: 1306583976
Provider Name (Legal Business Name): ERIC MICHAEL LABOUFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 MONTGOMERY DR STE 200
SANTA ROSA CA
95405-4801
US

IV. Provider business mailing address

115 MULBERRY LN
NEWTOWN SQUARE PA
19073-4605
US

V. Phone/Fax

Practice location:
  • Phone: 707-547-5437
  • Fax: 707-547-5430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD486516
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMT225821
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA208809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: