Healthcare Provider Details

I. General information

NPI: 1194083949
Provider Name (Legal Business Name): JUSTIN SCOTT LIBERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 SENECA ST H8-GME
SEATTLE WA
98101-2742
US

IV. Provider business mailing address

1100 9TH AVE
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-583-6079
  • Fax: 206-583-2307
Mailing address:
  • Phone: 206-583-6079
  • Fax: 206-583-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54041
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61025358
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: