Provider Demographics
NPI:1164705794
Name:LOREN E. LAYBOURN, MD PS
Entity Type:Organization
Organization Name:LOREN E. LAYBOURN, MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-533-1576
Mailing Address - Street 1:PO BOX 1898
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-0315
Mailing Address - Country:US
Mailing Address - Phone:360-533-1576
Mailing Address - Fax:360-637-8732
Practice Address - Street 1:100 S I ST
Practice Address - Street 2:STE. 103
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6502
Practice Address - Country:US
Practice Address - Phone:360-533-1576
Practice Address - Fax:360-637-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000468442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty