Provider Demographics
NPI:1881644599
Name:LABAKI, RANDALL L (DO)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
Last Name:LABAKI
Suffix:
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 1:3060 SHAW RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 KENWOOD DR
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1997
Practice Address - Country:US
Practice Address - Phone:740-623-2323
Practice Address - Fax:740-623-0654
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005788L207P00000X
OH34-005788208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0931915Medicaid
OH000000302734OtherBCBS
P00034687OtherRAIL ROAD MEDICARE
OHP00034684OtherMEDICARE RAIL ROAD
OHP00034684OtherMEDICARE RAIL ROAD
F65274Medicare UPIN
OH0931915Medicaid