MEDICARE: DR. JOHN PAUL LAVELLE MB, BCH, FRCSI

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	208800000X	Urology Physician	200000870	NC

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	:	1962405449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PAUL LAVELLE MB, BCH, FRCSI

Provider Business Mailing Address
First Line	:	3801 MIRANDA AVE
Second Line	:	B3-117 BLDG 100 UROLOGY (#112)
City	:	PALO ALTO
State	:	CA
Zip	:	94304-1207
Country	:	US
Telephone Number	:	650-493-5000
Fax Number	:	650-849-0319

Provider Business Practice Location Address
First Line	:	3801 MIRANDA AVE
Second Line	:	B3-117 BLDG 100 UROLOGY (#112)
City	:	PALO ALTO
State	:	CA
Zip	:	94304-1207
Country	:	US
Telephone Number	:	650-493-5000
Fax Number	:	650-849-0319

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/15/2008

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