Healthcare Provider Details

I. General information

NPI: 1326196957
Provider Name (Legal Business Name): EUGENE SHANER LEBAUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 BRASSFIELD RD SUITE 400
GREENSBORO NC
27410-9682
US

IV. Provider business mailing address

3201 BRASSFIELD RD SUITE 400
GREENSBORO NC
27410-9682
US

V. Phone/Fax

Practice location:
  • Phone: 336-282-2300
  • Fax: 336-282-0034
Mailing address:
  • Phone: 336-282-2300
  • Fax: 336-282-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number14712
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: