Individual
DOUGLAS LAVENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
C10002822
DE
207W00000X
Ophthalmology Physician
Primary
D0036586
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000542402
—
DE
05
—
116251900
—
MD
Enumeration date
05/02/2006
Last updated
04/13/2012
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