Healthcare Provider Details

I. General information

NPI: 1952402273
Provider Name (Legal Business Name): JEFFREY LIEBERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

21097 NE 27TH CT STE 480
AVENTURA FL
33180-1235
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-4443
  • Fax: 239-436-5907
Mailing address:
  • Phone: 786-428-1059
  • Fax: 786-428-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME118058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: