Provider Demographics
NPI:1255994034
Name:LRD, LLC
Entity type:Organization
Organization Name:LRD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-900-5828
Mailing Address - Street 1:1601 RUTHERFORD LN STE 200A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5125
Mailing Address - Country:US
Mailing Address - Phone:512-900-5828
Mailing Address - Fax:
Practice Address - Street 1:1601 RUTHERFORD LN STE 200A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5125
Practice Address - Country:US
Practice Address - Phone:512-900-5828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty