Healthcare Provider Details

I. General information

NPI: 1407864143
Provider Name (Legal Business Name): DEAN LIEBERMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5507 S CONGRESS AVE SUITE 150
ATLANTIS FL
33462-1139
US

IV. Provider business mailing address

5507 S CONGRESS AVE SUITE 150
ATLANTIS FL
33462-1139
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-4444
  • Fax:
Mailing address:
  • Phone: 561-433-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9100994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: