Healthcare Provider Details

I. General information

NPI: 1770575011
Provider Name (Legal Business Name): MARSHALL R LAPLATA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 N WASHINGTON ST
TULLAHOMA TN
37388-2221
US

IV. Provider business mailing address

PO BOX 299
MANCHESTER TN
37349-0299
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-2005
  • Fax: 931-455-4450
Mailing address:
  • Phone: 931-728-5607
  • Fax: 931-728-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO1201
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: