Provider Demographics
NPI:1003286931
Name:ERIC E. LUEBBERT, D.O., P.C.
Entity type:Organization
Organization Name:ERIC E. LUEBBERT, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LUEBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-468-7000
Mailing Address - Street 1:133 HILLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-1122
Mailing Address - Country:US
Mailing Address - Phone:417-468-7000
Mailing Address - Fax:
Practice Address - Street 1:133 HILLSBORO ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-1122
Practice Address - Country:US
Practice Address - Phone:417-468-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285694497OtherNPI
1285694497OtherNPI