Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME50857 | FL |
NPI | 1891720488 |
---|---|
Provider Name | Marc E Lieberman |
First Address | Vero Beach, FL 32960-4875 |
Second Address | Vero Beach, FL 32960-4875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D50857 | (02) | FL |