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General NPI Number Information
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NPI Number | 1871537563
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Entity Type | Individual
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Provider Name | THOMAS F LIEB M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 2020 NE 61ST AVE
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City | PORTLAND
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State | OR
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Zip | 97213
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Country | US
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Telephone | 314-402-6504
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 NE 61ST AVE
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City | PORTLAND
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State | OR
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Zip | 97213-4144
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Country | US
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Telephone | 314-402-6504
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | R4N13
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD00021605
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License Number State | WA
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