Provider Demographics
NPI:1992937676
Name:LENABURG, HARRY JAMES JR (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:JAMES
Last Name:LENABURG
Suffix:JR
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 1:1617 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4008
Mailing Address - Country:US
Mailing Address - Phone:623-824-3628
Mailing Address - Fax:318-449-8495
Practice Address - Street 1:104 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8581
Practice Address - Country:US
Practice Address - Phone:318-449-1370
Practice Address - Fax:318-449-8495
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA308405208100000X
AZ46637208100000X
GA069064208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2487736Medicaid