Healthcare Provider Details

I. General information

NPI: 1124094834
Provider Name (Legal Business Name): ERIC LIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2773 HARRIS ST STE A
EUREKA CA
95503-4866
US

IV. Provider business mailing address

PO BOX 994032
REDDING CA
96099-4032
US

V. Phone/Fax

Practice location:
  • Phone: 707-444-9664
  • Fax: 707-444-8747
Mailing address:
  • Phone: 530-241-0473
  • Fax: 530-241-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG36034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: