Provider Demographics
NPI:1013962679
Name:LUBOW, LAWRENCE D (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:D
Last Name:LUBOW
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD123972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3047587Medicaid
TN64721343OtherKY MEDICAID
TNPENDINGOtherRAILROAD MEDICARE
TN4068957OtherBCBS
KY64721343Medicaid
TN1509289Medicaid
TN4018017OtherBCBS
TN4200784OtherBCBS TN
TN30475801Medicare PIN
TN4200784OtherBCBS TN
TN4018017OtherBCBS
KY64721343Medicaid