Provider Demographics
NPI:1700020229
Name:LAVALLEE, PHILIP J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:LAVALLEE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:WBAMC, ATTN: CREDENTIALS, MS ANA RODRIGUEZ
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-569-1386
Mailing Address - Fax:915-569-4890
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:WBAMC, ATTN: CREDENTIALS, MS ANA RODRIGUEZ
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-569-1386
Practice Address - Fax:915-569-4890
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT76732083A0100X, 2083P0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice