Basic Information
| Provider Information | |||||||||
| NPI: | 1760793517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAUBACKER | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 CORTEZ RD W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342103142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413575550 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7915 US 301 N STE 107 | ||||||||
| Address2: | |||||||||
| City: | ELLENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342223532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418471101 | ||||||||
| FaxNumber: | 9414172811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2010 | ||||||||
| LastUpdateDate: | 08/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 076602 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | OS12565 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | OS17440 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.