Provider Demographics
NPI:1851370431
Name:LAUTERBACH, JOSEPH C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:LAUTERBACH
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 1:817 COOK DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3485
Mailing Address - Country:US
Mailing Address - Phone:423-745-3394
Mailing Address - Fax:423-745-3396
Practice Address - Street 1:817 COOK DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3485
Practice Address - Country:US
Practice Address - Phone:423-745-3394
Practice Address - Fax:423-745-3396
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNM.D. 39784174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH96940Medicare UPIN
TN3332414Medicare ID - Type Unspecified