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General NPI Number Information
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NPI Number | 1679679179
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Entity Type | Individual
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Provider Name | SCOTT LIEBERMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 15466 LOS GATOS BLVD STE 109-280
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City | LOS GATOS
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State | CA
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Zip | 95032-2542
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Country | US
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Telephone | 408-358-0334
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Fax |
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Provider Business Mailing Address
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Address Line | 15466 LOS GATOS BLVD STE 109-280
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City | LOS GATOS
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State | CA
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Zip | 95032-2542
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Country | US
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Telephone | 408-358-0334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G58630
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G3556
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License Number State | TX
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