Provider Demographics
NPI:1588811137
Name:GENERAL AND ADVANCED LAPAROSCOPIC SURGERY, LLC
Entity Type:Organization
Organization Name:GENERAL AND ADVANCED LAPAROSCOPIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:REX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-682-2038
Mailing Address - Street 1:3520 GUION RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1692
Mailing Address - Country:US
Mailing Address - Phone:317-682-2038
Mailing Address - Fax:317-920-7482
Practice Address - Street 1:3520 GUION RD
Practice Address - Street 2:SUITE 103
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1692
Practice Address - Country:US
Practice Address - Phone:317-682-2038
Practice Address - Fax:317-920-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003334A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty