Provider Demographics
NPI:1528153186
Name:LABADIE, ENRIQUE LUIS (MD, FAAN)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:LUIS
Last Name:LABADIE
Suffix:
Gender:M
Credentials:MD, FAAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 CALLE DOS CABEZAS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718
Mailing Address - Country:US
Mailing Address - Phone:520-299-3402
Mailing Address - Fax:
Practice Address - Street 1:5140 CALLE DOS CABEZAS
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-7009
Practice Address - Country:US
Practice Address - Phone:520-299-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 90672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL6950287OtherDEA