Healthcare Provider Details

I. General information

NPI: 1063404697
Provider Name (Legal Business Name): HUGH PETER LIEBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 59TH ST W
BRADENTON FL
34209-4607
US

IV. Provider business mailing address

1400 59TH ST W
BRADENTON FL
34209-4607
US

V. Phone/Fax

Practice location:
  • Phone: 941-795-2468
  • Fax: 941-794-4093
Mailing address:
  • Phone: 941-795-2468
  • Fax: 941-794-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME0059650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: