Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME58681 | FL |
N | 207R00000X | Internist | ME58681 | FL |
N | 111NI0900X | Internist | ME58681 | FL |
N | 207RA0401X | Internist - Addiction Medicine | ME58681 | FL |
NPI | 1194798942 |
---|---|
Provider Name | Drew Evan Lieberman |
First Address | Pembroke Pines, FL 33025-4561 |
Second Address | Plantation, FL 33324-1811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 18/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
052099300 | (05) | FL |
E78984 | (02) | |
P00446368 | RAILROAD MEDICARE (01) | FL |