Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 5267 | SC |
N | 208D00000X | General Practice Physician | 5267 | SC |
NPI | 1326254012 |
---|---|
Provider Name | Dr. Allan Daniel Lieberman |
First Address | North Charleston, SC 29420-4247 |
Second Address | North Charleston, SC 29420-4247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D17499 | (02) | SC |