Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | F4926 | TX |
Y | 207VG0400X | Gynecologist | F4926 | TX |
NPI | 1023017001 |
---|---|
Provider Name | Maurice N Leibman |
First Address | Houston, TX 77024-4047 |
Second Address | Houston, TX 77024-4047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 23/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1319485-05 | (05) | TX |
160006654- | MEDICARE RR-SW LOCATION (01) | TX |
4565782-002 | CIGNA (01) | TX |
682896 | AETNA (01) | TX |
88W578 | BC/BS (01) | TX |
B24328 | (02) | TX |
TXB113640 | MEDICARE PTAN (01) | TX |