MEDICARE: DR. PHILIP THEODORE LABARBERA M.D.

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	207Q00000X	Family Medicine Physician	D8315	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528020823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP THEODORE LABARBERA M.D.

Provider Business Mailing Address
First Line	:	4944 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1265
Country	:	US
Telephone Number	:	936-564-3751
Fax Number	:	936-560-5871

Provider Business Practice Location Address
First Line	:	4944 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1265
Country	:	US
Telephone Number	:	936-564-3751
Fax Number	:	936-560-5871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	11/23/2009

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