Provider Demographics
NPI:1528064458
Name:LAUBENTHAL, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:LAUBENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:2226 THOMAS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-5814
Practice Address - Country:US
Practice Address - Phone:850-249-7400
Practice Address - Fax:850-249-7424
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2012-03-15
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
FL61596, 38589OtherBC OF FL: INDIVID AND GRP
FLME79504OtherFLORIDA LICENSE NUMBER
FLME79504OtherFLORIDA LICENSE NUMBER
FL61596ZMedicare ID - Type Unspecified