Provider Demographics
NPI:1114989175
Name:LABASH, JD (DO)
Entity Type:Individual
Prefix:
First Name:JD
Middle Name:
Last Name:LABASH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:25 1ST AVE W
Mailing Address - Street 2:STE 150
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5149
Mailing Address - Country:US
Mailing Address - Phone:701-483-6777
Mailing Address - Fax:701-483-6776
Practice Address - Street 1:1173 3RD AVE W
Practice Address - Street 2:STE 12
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3852
Practice Address - Country:US
Practice Address - Phone:701-483-6777
Practice Address - Fax:701-483-6776
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-03-04
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Provider Licenses
StateLicense IDTaxonomies
ND8402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11210Medicaid
ND20316OtherBCBS OF ND
ND20316OtherBCBS OF ND
H11689Medicare UPIN