Provider Demographics
NPI:1184796211
Name:LAUBENTHAL, JEFFERY C (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:C
Last Name:LAUBENTHAL
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 1:100 RICE MINE ROAD LOOP
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2414
Mailing Address - Country:US
Mailing Address - Phone:205-339-0171
Mailing Address - Fax:205-333-8681
Practice Address - Street 1:100 RICE MINE ROAD LOOP
Practice Address - Street 2:SUITE 206
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2414
Practice Address - Country:US
Practice Address - Phone:205-339-0171
Practice Address - Fax:205-333-8681
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009956980Medicaid
AL051550724Medicare PIN
ALG83383Medicare UPIN
AL009956980Medicaid