Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME137337 | FL |
NPI | 1053622183 |
---|---|
Provider Name | Anthony Liberatore |
First Address | Stuart, FL 34995-0417 |
Second Address | Stuart, FL 34997 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 21/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TSBGW | FLORIDA BLUE (01) | FL |