MEDICARE: MARC K LAPHAM CRTT

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	227800000X	Certified Respiratory Therapist	102727	CA

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	:	1689837395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC K LAPHAM CRTT

Provider Business Mailing Address
First Line	:	PO BOX 1679
Second Line	:
City	:	BIG BEAR CITY
State	:	CA
Zip	:	92314-1679
Country	:	US
Telephone Number	:	909-585-1339
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 MONTE VISTA DR
Second Line	:
City	:	BIG BEAR CITY
State	:	CA
Zip	:	92314-9050
Country	:	US
Telephone Number	:	909-585-1339
Fax Number	:

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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