MEDICARE: LAWRENCE LABBATE MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1134471840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE LABBATE MD PLLC

Provider Business Mailing Address
First Line	:	4100 S LOOKOUT ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-2030
Country	:	US
Telephone Number	:	501-223-9948
Fax Number	:	501-223-2941

Provider Business Practice Location Address
First Line	:	4100 S LOOKOUT ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-2030
Country	:	US
Telephone Number	:	501-223-9948
Fax Number	:	501-223-2941

Authorized Official
Title or Position	:	OWNER
Name	:	LAWRENCE LABBATE
Credential	:
Telephone Number	:	501-223-9948

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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