Provider Demographics
NPI:1063733988
Name:LAUTERBACH, SETH
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:LAUTERBACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-2349
Mailing Address - Country:US
Mailing Address - Phone:402-310-7913
Mailing Address - Fax:
Practice Address - Street 1:1017 GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333
Practice Address - Country:US
Practice Address - Phone:402-310-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical