Healthcare Provider Details

I. General information

NPI: 1275723520
Provider Name (Legal Business Name): FRED A LIEBOWITZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 DIAMOND CENTRE CT 700-1
FORT MYERS FL
33912-4365
US

IV. Provider business mailing address

6150 DIAMOND CENTRE CT 700-1
FORT MYERS FL
33912-4365
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-1000
  • Fax: 239-278-0501
Mailing address:
  • Phone: 239-278-1000
  • Fax: 239-278-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME60344
License Number StateFL

VIII. Authorized Official

Name: DR. FRED ALLAN LIEBOWITZ
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 239-278-1000