MEDICARE: DR. MARK IRA LEIBOWITZ 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	208800000X	Urology Physician	2003-0544	NM

General Provider Information

NPI Number	:	1508864919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK IRA LEIBOWITZ M.D.

Provider Business Mailing Address
First Line	:	4527 N SWAN ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-4720
Country	:	US
Telephone Number	:	505-534-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1264 E 32ND ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7229
Country	:	US
Telephone Number	:	505-534-1444
Fax Number	:	505-534-1449

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	07/08/2007

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