Provider Demographics
NPI:1063495075
Name:LIEBERMAN, GARY J (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:STE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-431-8000
Mailing Address - Fax:954-436-0449
Practice Address - Street 1:400 N HIATUS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5214
Practice Address - Country:US
Practice Address - Phone:954-431-8000
Practice Address - Fax:954-436-0449
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-10-08
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Provider Licenses
StateLicense IDTaxonomies
FLME34672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066953900Medicaid