Provider Demographics
NPI:1528020823
Name:LABARBERA, PHILIP THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:THEODORE
Last Name:LABARBERA
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 1:4944 NE STALLINGS DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1265
Mailing Address - Country:US
Mailing Address - Phone:936-564-3751
Mailing Address - Fax:936-560-5871
Practice Address - Street 1:4944 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1265
Practice Address - Country:US
Practice Address - Phone:936-564-3751
Practice Address - Fax:936-560-5871
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120206104Medicaid