MEDICARE: STEVEN J. LEIB, M.D., INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G416080	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1811197999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN J. LEIB, M.D., INC

Provider Business Mailing Address
First Line	:	5610 SCOTTS VALLEY DR
Second Line	:	SUITE A
City	:	SCOTTS VALLEY
State	:	CA
Zip	:	95066-3476
Country	:	US
Telephone Number	:	831-438-9141
Fax Number	:	831-438-2030

Provider Business Practice Location Address
First Line	:	5610 SCOTTS VALLEY DR
Second Line	:	SUITE A
City	:	SCOTTS VALLEY
State	:	CA
Zip	:	95066-3476
Country	:	US
Telephone Number	:	831-438-9141
Fax Number	:	831-438-2030

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN LEIB
Credential	:	M.D.
Telephone Number	:	831-438-9141

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

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