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General NPI Number Information
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NPI Number | 1033989652
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Entity Type | Organization
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Legal Business Name | KEITH LEIBOWITZ M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 203 PARK AVE
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City | MODESTO
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State | CA
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Zip | 95354-0557
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Country | US
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Telephone | 757-645-7079
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Fax |
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Provider Business Mailing Address
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Address Line | 203 PARK AVE
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City | MODESTO
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State | CA
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Zip | 95354-0557
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Country | US
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Telephone | 757-645-7079
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH A LEIBOWITZ
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Credential | MD
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Telephone | 757-645-7079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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