MEDICARE: GREGORY J. LIEBSCHER 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	208200000X	Plastic Surgery Physician	33468	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LIA35161	OTHER	CO	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922067263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY J. LIEBSCHER MD

Provider Business Mailing Address
First Line	:	5901 CORPORATE DR
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80919-1941
Country	:	US
Telephone Number	:	719-634-2503
Fax Number	:	719-634-2686

Provider Business Practice Location Address
First Line	:	5901 CORPORATE DR
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80919-1941
Country	:	US
Telephone Number	:	719-634-2503
Fax Number	:	719-634-2686

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	04/08/2009

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