Organization
LAPORTE OSTEOPATHIC FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLAYTON BERT ALEXANDER D.O. (PRESIDENT/ DOCTOR)
(219) 325-0155
Entity
Organization
Contact information
Practice address
125 EAST SHORE PARKWAY, SUITE D, LA PORTE, IN 46350-5677
(219) 325-0155
Mailing address
125 EAST SHORE PARKWAY, SUITE D, LA PORTE, IN 46350-5672
(219) 325-0155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084179
ANTHEM BLUE CROSS
IN
01
—
080025306
MEDICARE RAILROAD
IN
05
—
100164980
—
IN
01
—
15D0355679
CLIA
IN
Enumeration date
09/04/2007
Last updated
12/08/2020
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