Healthcare Provider Details

I. General information

NPI: 1053622183
Provider Name (Legal Business Name): ANTHONY LIBERATORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 SE SALERNO RD
STUART FL
34997
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-5777
  • Fax: 772-223-5789
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME137337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: