Provider Demographics
NPI:1811269558
Name:LIBSCH, LAWRENCE RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RUSSELL
Last Name:LIBSCH
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 1:23383 WATER CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-8542
Mailing Address - Country:US
Mailing Address - Phone:561-368-1386
Mailing Address - Fax:
Practice Address - Street 1:23383 WATER CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-8542
Practice Address - Country:US
Practice Address - Phone:561-368-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 26722207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology