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NPI Code Detail

MEDICARE: DR. JONATHAN T LIEBIG M.D.

MEDICARE: DR. JONATHAN T LIEBIG 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
12086S0127XTrauma Surgery PhysicianC184408CA
2208600000XSurgery Physician18957NV

General Provider Information

NPI Number : 1760687925
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN T LIEBIG M.D.
Provider Business Mailing Address
First Line : 550 WASHINGTON ST STE 641
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-2229
Country : US
Telephone Number : 619-298-3100
Fax Number :
Provider Business Practice Location Address
First Line : 1707 W CHARLESTON BLVD STE 160
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2354
Country : US
Telephone Number : 702-671-5150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2007
Last Update Date : 07/19/2023

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