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NPI Code Detail

MEDICARE: JOSHUA R LEIBOVITZ MD

MEDICARE: JOSHUA R LEIBOVITZ 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
12084A0401XAddiction Medicine (Psychiatry & Neurology) PhysicianMD21268OR
2207P00000XEmergency Medicine PhysicianMD21268OR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01328167OTHERORRR MEDICARE - PROVIDENCE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912929910
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA R LEIBOVITZ MD
Provider Business Mailing Address
First Line : 2600 SE BELMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2916
Country : US
Telephone Number : 503-475-2844
Fax Number :
Provider Business Practice Location Address
First Line : 2600 SE BELMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2916
Country : US
Telephone Number : 503-475-2844
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 01/16/2024

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Directions to “ JOSHUA R LEIBOVITZ MD” Practice Location

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