Healthcare Provider Details

I. General information

NPI: 1346284866
Provider Name (Legal Business Name): THAD ANTHONY LABBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MALLARD LN
TAYLOR TX
76574-1214
US

IV. Provider business mailing address

603 MALLARD LN
TAYLOR TX
76574-1214
US

V. Phone/Fax

Practice location:
  • Phone: 512-352-7664
  • Fax: 512-365-5237
Mailing address:
  • Phone: 512-352-7664
  • Fax: 512-365-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2006008752
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberM6716
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: