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General NPI Number Information
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NPI Number | 1598119919
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Entity Type | Organization
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Legal Business Name | DOUGLAS F LIEB MD LLC
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 1053 MEDICAL CENTER DR STE 242
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City | ORANGE CITY
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State | FL
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Zip | 32763-8261
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Country | US
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Telephone | 386-456-0210
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Fax | 386-456-0219
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Provider Business Mailing Address
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Address Line | 1053 MEDICAL CENTER DR STE 242
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City | ORANGE CITY
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State | FL
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Zip | 32763-8261
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Country | US
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Telephone | 386-456-0210
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Fax | 386-456-0219
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS F LIEB
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Credential | M.D.
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Telephone | 407-739-2598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME82424
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME82424
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME82424
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License Number State | FL
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