Healthcare Provider Details

I. General information

NPI: 1548266323
Provider Name (Legal Business Name): LEONARD W. LABUSH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2005
Last Update Date: 10/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WATERMAN ST
PROVIDENCE RI
02906-3116
US

IV. Provider business mailing address

54 OTHMAR ST
NARRAGANSETT RI
02882-3346
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-3390
  • Fax: 401-621-7747
Mailing address:
  • Phone: 401-783-9217
  • Fax: 401-621-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM00171
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: