Healthcare Provider Details

I. General information

NPI: 1184732109
Provider Name (Legal Business Name): BRIAN FRANCIS LIEBERSBACH MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 VANCE TRL
THE VILLAGES FL
32162-8719
US

IV. Provider business mailing address

1051 VANCE TRL
THE VILLAGES FL
32162-8719
US

V. Phone/Fax

Practice location:
  • Phone: 352-561-4715
  • Fax: 352-561-4376
Mailing address:
  • Phone: 352-561-4715
  • Fax: 352-561-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberME82125
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME82125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: