Individual
DR. ROGER S. LABONTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1314 19TH AVE, MERIDIAN, MS 39301-4116
(601) 703-4078
(601) 703-4065
Mailing address
PO BOX 5183, MERIDIAN, MS 39302-5183
(601) 703-9506
(601) 703-3264
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
12417
MS
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
12417
MS
208M00000X
Hospitalist Physician
Primary
12417
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119505
—
MS
05
—
009905660
—
AL
01
—
110167965
RAILROAD MEDICARE
—
01
—
731-02315
BLUE CROSS OF AL
—
Enumeration date
11/16/2005
Last updated
06/01/2010
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