Healthcare Provider Details

I. General information

NPI: 1184608085
Provider Name (Legal Business Name): ROBERT J LIEBIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 GREGORY LN
PLEASANT HILL CA
94523-2765
US

IV. Provider business mailing address

602 GREGORY LN
PLEASANT HILL CA
94523-2765
US

V. Phone/Fax

Practice location:
  • Phone: 925-685-1047
  • Fax:
Mailing address:
  • Phone: 925-685-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG52684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: