Healthcare Provider Details

I. General information

NPI: 1891720488
Provider Name (Legal Business Name): MARC E LIEBERMAN M.D. F.A.C.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 36TH ST STE A
VERO BEACH FL
32960-4875
US

IV. Provider business mailing address

1600 36TH ST STE A
VERO BEACH FL
32960-4875
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-7801
  • Fax: 772-569-9252
Mailing address:
  • Phone: 772-569-7801
  • Fax: 772-569-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME50857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: