Provider Demographics
NPI:1952335002
Name:LABOWE, MARK LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LAWRENCE
Last Name:LABOWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1007
Mailing Address - Country:US
Mailing Address - Phone:310-824-2550
Mailing Address - Fax:310-824-7050
Practice Address - Street 1:12301 WILSHIRE BLVD
Practice Address - Street 2:SUITE 325
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1007
Practice Address - Country:US
Practice Address - Phone:310-824-2550
Practice Address - Fax:310-824-7050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG524842086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG52484OtherMEDICAL LICENSE NUMBER
95-4065292OtherCORPORATE TAX I.D.
A93153Medicare UPIN