Healthcare Provider Details

I. General information

NPI: 1841365764
Provider Name (Legal Business Name): LIBERTY DAYTON MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 N TRAVIS ST
LIBERTY TX
77575-3549
US

IV. Provider business mailing address

1353 N TRAVIS ST
LIBERTY TX
77575-3549
US

V. Phone/Fax

Practice location:
  • Phone: 936-336-7316
  • Fax: 936-336-8581
Mailing address:
  • Phone: 936-336-7316
  • Fax: 936-336-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALBERT B SCHWARZER
Title or Position: MANAGING PARTNER
Credential:
Phone: 817-738-1993