Provider Demographics
NPI:1124355326
Name:STOMBAUGH, LAURETTA GINEX (DO)
Entity type:Individual
Prefix:
First Name:LAURETTA
Middle Name:GINEX
Last Name:STOMBAUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 BEVERLY HANKS CTR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2305
Mailing Address - Country:US
Mailing Address - Phone:828-693-3296
Mailing Address - Fax:828-692-6450
Practice Address - Street 1:157 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4189
Practice Address - Country:US
Practice Address - Phone:828-884-3440
Practice Address - Fax:828-884-6613
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01-727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics