Provider Demographics
NPI:1417356007
Name:LUFBOROUGH, BEAU
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:
Last Name:LUFBOROUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 KNIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-2425
Mailing Address - Country:US
Mailing Address - Phone:406-439-8619
Mailing Address - Fax:
Practice Address - Street 1:605 KNIGHT ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2524
Practice Address - Country:US
Practice Address - Phone:406-439-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT161378171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications