Healthcare Provider Details

I. General information

NPI: 1871518985
Provider Name (Legal Business Name): GERALD J LIEBERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/24/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HUMPHREYS CENTER SUITE 200
MEMPHIS TN
38120
US

IV. Provider business mailing address

8688 PLAYERS FAIRWAY DRIVE
MEMPHIS TN
38125
US

V. Phone/Fax

Practice location:
  • Phone: 901-578-2538
  • Fax: 901-578-2572
Mailing address:
  • Phone: 901-487-7713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number14850
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: