Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME0048840 | FL |
NPI | 1063407724 |
---|---|
Provider Name | Dr. Mark Alan Lieberfarb |
First Address | Lake Worth, FL 33467-2964 |
Second Address | Lake Worth, FL 33467-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D21223 | (02) | FL |