Healthcare Provider Details

I. General information

NPI: 1427421130
Provider Name (Legal Business Name): LIEBELT FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 SE 17TH ST SUITE 100
OCALA FL
34471-5586
US

IV. Provider business mailing address

3515 SE 17TH ST SUITE 100
OCALA FL
34471-5586
US

V. Phone/Fax

Practice location:
  • Phone: 352-509-9470
  • Fax: 352-861-7725
Mailing address:
  • Phone: 352-509-9470
  • Fax: 352-861-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0056468
License Number StateFL

VIII. Authorized Official

Name: DR. DONALD W LIEBELT
Title or Position: CEO
Credential: MD
Phone: 352-509-9470