Healthcare Provider Details

I. General information

NPI: 1932218179
Provider Name (Legal Business Name): GARY ARTHUR LIEBER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CLINT MOORE RD SUITE 130
BOCA RATON FL
33487-2768
US

IV. Provider business mailing address

1601 CLINT MOORE RD SUITE 130
BOCA RATON FL
33487-2768
US

V. Phone/Fax

Practice location:
  • Phone: 561-995-0229
  • Fax: 561-989-0775
Mailing address:
  • Phone: 561-995-0229
  • Fax: 561-989-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO-1448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: