Provider Demographics
NPI:1336331594
Name:LAWRENCE J HERBERHULZ MD, PC
Entity Type:Organization
Organization Name:LAWRENCE J HERBERHULZ MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERBERHULZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-259-0185
Mailing Address - Street 1:911 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2509
Mailing Address - Country:US
Mailing Address - Phone:256-259-0185
Mailing Address - Fax:256-259-0317
Practice Address - Street 1:911 S BROAD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2509
Practice Address - Country:US
Practice Address - Phone:256-259-0185
Practice Address - Fax:256-259-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51524140OtherBLUE CROSS
G-94649Medicare UPIN
AL51524140OtherBLUE CROSS