Healthcare Provider Details

I. General information

NPI: 1346392982
Provider Name (Legal Business Name): JAMES R LIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST SUITE 1440
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

1229 MADISON ST SUITE 1440
SEATTLE WA
98104-3586
US

V. Phone/Fax

Practice location:
  • Phone: 206-625-0578
  • Fax: 206-625-9184
Mailing address:
  • Phone: 206-625-0578
  • Fax: 206-625-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00038663
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: