Provider Demographics
NPI:1437266947
Name:LAUBENHEIMER, STEVEN PHILLIP (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:PHILLIP
Last Name:LAUBENHEIMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 GOODYEAR AVE
Mailing Address - Street 2:BUILDING 400 SUITE 302
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1194
Mailing Address - Country:US
Mailing Address - Phone:256-492-7246
Mailing Address - Fax:256-492-6146
Practice Address - Street 1:1026 GOODYEAR AVE
Practice Address - Street 2:BUILDING 400 SUITE 302
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1194
Practice Address - Country:US
Practice Address - Phone:256-492-7246
Practice Address - Fax:256-492-6146
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-414363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934051Medicaid
AL51525980OtherBLUE CROSS
AL009934051Medicaid
AL051525980Medicare ID - Type Unspecified