MEDICARE: DR. BETH L. LIEBOWITZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	ME0062288	FL
2	207V00000X	Obstetrics & Gynecology Physician	Q2155	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23082	OTHER		BC/BS

General Provider Information

NPI Number	:	1699739888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH L. LIEBOWITZ M.D.

Provider Business Mailing Address
First Line	:	6453 VILAGGIO DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-2926
Country	:	US
Telephone Number	:	641-204-9802
Fax Number	:

Provider Business Practice Location Address
First Line	:	6453 VILAGGIO DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-2926
Country	:	US
Telephone Number	:	641-204-9802
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	10/13/2019

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