Provider Demographics
NPI:1356416374
Name:J L L MD INC
Entity type:Organization
Organization Name:J L L MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAUBENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-249-7400
Mailing Address - Street 1:PO BOX 28480
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32411-8480
Mailing Address - Country:US
Mailing Address - Phone:850-249-7400
Mailing Address - Fax:850-249-7424
Practice Address - Street 1:1813 THOMAS DR
Practice Address - Street 2:STE 6
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-5834
Practice Address - Country:US
Practice Address - Phone:850-249-7400
Practice Address - Fax:850-249-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME795042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61596ZOtherBCBS OF FL
FL61596ZOtherBCBS OF FL
FLAA798Medicare PIN
FL61596YMedicare PIN