Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 073020 | GA |
Y | 207YS0123X | Facial Plastic Surgeon | 60671191 | WA |
NPI | 1740592849 |
---|---|
Provider Name | Dr. Daniel James Liebertz |
First Address | Kirkland, WA 98033-7355 |
Second Address | Kirkland, WA 98033-7355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 06/02/2020 |