Provider Demographics
NPI:1760793517
Name:LAUBACKER, GARY JOSEPH JR (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:JOSEPH
Last Name:LAUBACKER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3142
Mailing Address - Country:US
Mailing Address - Phone:941-357-5550
Mailing Address - Fax:
Practice Address - Street 1:7915 US 301 N STE 107
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3532
Practice Address - Country:US
Practice Address - Phone:941-847-1101
Practice Address - Fax:941-417-2811
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076602207R00000X
FLOS12565207R00000X
FLOS17440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine