Healthcare Provider Details

I. General information

NPI: 1134412760
Provider Name (Legal Business Name): SCOTT MITCHELL LIEBERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N STATE ROAD 7 STE 305
MARGATE FL
33063-5737
US

IV. Provider business mailing address

8600 SW 92ND ST STE 204A
MIAMI FL
33156-7377
US

V. Phone/Fax

Practice location:
  • Phone: 954-442-8126
  • Fax: 954-659-5425
Mailing address:
  • Phone: 305-436-9933
  • Fax: 305-436-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME122868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: