MEDICARE: DR. STEVEN J LEIB 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	207Q00000X	Family Medicine Physician	00G416080	CA

General Provider Information

NPI Number	:	1740245034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN J LEIB MD

Provider Business Mailing Address
First Line	:	9500 CENTRAL AVE
Second Line	:
City	:	BEN LOMOND
State	:	CA
Zip	:	95005-9349
Country	:	US
Telephone Number	:	831-336-3200
Fax Number	:	831-336-3203

Provider Business Practice Location Address
First Line	:	6222 HIGHWAY 9
Second Line	:
City	:	FELTON
State	:	CA
Zip	:	95018-9713
Country	:	US
Telephone Number	:	831-335-9141
Fax Number	:	831-335-1341

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	08/29/2016

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