Larry Brent Fishbaugh, D.O.
Individual provider Active NPI Family Medicine Physician · Paulding, OH
NPI 1417907320 · NPPES record last updated Jan 17, 2008
Key facts
- NPI
- 1417907320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 34-001653F (OH)
- Practice address
- 220 W Perry St
Paulding, OH 45879-1452 - Phone
- (419) 399-4771
- NPI assigned
- May 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34-001653F | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Paulding County Hospital Physician Services | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 34-001653F | OH | Yes |
Addresses
Primary practice location
220 W Perry St
Paulding, OH 45879-1452
Mailing address
1032 W Wayne St
Paulding, OH 45879-1545
Phone (419) 399-2045
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0056353 | Medicaid | OH |
Other providers in Paulding, OH
- Rod Dudgeon
- Christina S Dunderman
- Cindy Durliat
- Lauren Favorite
- Kristina Figgins
- Dennis Michael Fitzgerald
- Rose Foltz
- Fort Wayne Cardiology Corporation
- Jody L Fraley
- Gardens at Paulding Operating Company, LLC
All providers in Paulding, OH · Family Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.