Provider Demographics
NPI:1659472181
Name:LABIB, LABIB ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:LABIB
Middle Name:ALBERT
Last Name:LABIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALBERT
Other - Middle Name:L
Other - Last Name:LABIB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-366-2983
Mailing Address - Fax:
Practice Address - Street 1:11603 STATE AVE
Practice Address - Street 2:SUITE G
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8465
Practice Address - Country:US
Practice Address - Phone:360-658-6800
Practice Address - Fax:360-658-6819
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017763Medicaid
WAG8878393Medicare PIN
WA1017763Medicaid
WAGAB08385Medicare PIN