MEDICARE: LIAT LE M.D.

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	207Q00000X	Family Medicine Physician	ME99123	FL

General Provider Information

NPI Number	:	1396935813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIAT LE M.D.

Provider Business Mailing Address
First Line	:	3301 W GANDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-2931
Country	:	US
Telephone Number	:	813-925-1903
Fax Number	:	813-749-8370

Provider Business Practice Location Address
First Line	:	11969 SHELDON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3644
Country	:	US
Telephone Number	:	813-925-1903
Fax Number	:	813-749-8370

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

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	10/16/2012

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Directions to “ LIAT LE M.D.” Practice Location

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