Provider Demographics
NPI:1023017001
Name:LEIBMAN, MAURICE N (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:N
Last Name:LEIBMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12727 KIMBERLEY LN
Mailing Address - Street 2:202
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4047
Mailing Address - Country:US
Mailing Address - Phone:713-275-2990
Mailing Address - Fax:713-275-1694
Practice Address - Street 1:12727 KIMBERLEY LN
Practice Address - Street 2:202
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4047
Practice Address - Country:US
Practice Address - Phone:713-275-2990
Practice Address - Fax:713-275-1694
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4926207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX682896OtherAETNA
TX88W578OtherBC/BS
TX160006654-OtherMEDICARE RR-SW LOCATION
TX1319485-05Medicaid
TX4565782-002OtherCIGNA
TXTXB113640OtherMEDICARE PTAN
TX682896OtherAETNA
TX88W578OtherBC/BS