Healthcare Provider Details

I. General information

NPI: 1992937676
Provider Name (Legal Business Name): HARRY JAMES LENABURG JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N 3RD ST
ALEXANDRIA LA
71301-8581
US

IV. Provider business mailing address

1617 AUDUBON DR
ALEXANDRIA LA
71301-4008
US

V. Phone/Fax

Practice location:
  • Phone: 318-449-1370
  • Fax: 318-449-8495
Mailing address:
  • Phone: 623-824-3628
  • Fax: 318-449-8495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number308405
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number46637
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number069064
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: