Healthcare Provider Details

I. General information

NPI: 1407877004
Provider Name (Legal Business Name): JAY ADAM LIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST SUITE 400
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

850 POPLAR AVE BLDG 2
MEMPHIS TN
38105-4607
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax: 901-266-6488
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number48645
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number254120-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2006015608
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number48645
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: