Healthcare Provider Details

I. General information

NPI: 1366770596
Provider Name (Legal Business Name): GARY A LIEBER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD SUITE I-8
DELRAY BEACH FL
33484-6596
US

IV. Provider business mailing address

5130 LINTON BLVD SUITE I-8
DELRAY BEACH FL
33484-6596
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-0005
  • Fax: 561-495-0366
Mailing address:
  • Phone: 561-495-0005
  • Fax: 561-495-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO1448
License Number StateFL

VIII. Authorized Official

Name: DR. GARY A LIEBER
Title or Position: PRESIDENT
Credential: D
Phone: 561-495-0005