Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0131X | Foot Surgery | 1755 | MA |
N | 213ES0131X | Foot Surgery | 2280 | OH |
Y | 213ES0131X | Foot Surgery | 60015889 | WA |
N | 213ES0131X | Foot Surgery | N3760 | NY |
NPI | 1225116445 |
---|---|
Provider Name | Samuel Liebson |
First Address | Port Angeles, WA 98362-8264 |
Second Address | Port Angeles, WA 98362-8264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 02/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T80738 | (02) | OH |