MEDICARE: DR. MARK ALAN LIEBERFARB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	ME0048840	FL

General Provider Information

NPI Number	:	1063407724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALAN LIEBERFARB MD

Provider Business Mailing Address
First Line	:	6894 LAKE WORTH RD
Second Line	:	SUITE 204
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2964
Country	:	US
Telephone Number	:	561-641-4044
Fax Number	:	561-641-8524

Provider Business Practice Location Address
First Line	:	6894 LAKE WORTH RD
Second Line	:	SUITE 204
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2964
Country	:	US
Telephone Number	:	561-641-4044
Fax Number	:	561-641-8524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	11/30/2012

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