Provider Demographics
NPI:1497044341
Name:LAUBE, JUSTIN GRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GRAHAM
Last Name:LAUBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 SANTA MONICA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2067
Mailing Address - Country:US
Mailing Address - Phone:310-998-9118
Mailing Address - Fax:
Practice Address - Street 1:2336 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2095
Practice Address - Country:US
Practice Address - Phone:310-998-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine