Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 14712 | NC |
NPI | 1326196957 |
---|---|
Provider Name | Dr. Eugene Shaner Lebauer |
First Address | Greensboro, NC 27410-9682 |
Second Address | Greensboro, NC 27410-9682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0207779 | UNITED HEALTHCARE (01) | |
32679 | WELLPATH (01) | |
51330 | NC BLUE CROSS BLUE SHIELD (01) | NC |
82551 | MEDCOST (01) | |
8951330 | (05) | NC |
C85092 | (02) |