Healthcare Provider Details

I. General information

NPI: 1508040593
Provider Name (Legal Business Name): JOHN LABBAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S WALKER ST
BLOOMINGTON IN
47403-2158
US

IV. Provider business mailing address

650 S WALKER ST
BLOOMINGTON IN
47403-2158
US

V. Phone/Fax

Practice location:
  • Phone: 812-330-0909
  • Fax: 812-330-0099
Mailing address:
  • Phone: 812-330-0909
  • Fax: 812-330-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN R LABBAN
Title or Position: PROVIDER
Credential: MD
Phone: 812-330-0909