Provider Demographics
NPI:1093700197
Name:LIEBERMAN, LAWRENCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2010 59TH ST W STE 4200
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4687
Mailing Address - Country:US
Mailing Address - Phone:941-794-3999
Mailing Address - Fax:794-792-4048
Practice Address - Street 1:2010 59TH ST W STE 4200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4687
Practice Address - Country:US
Practice Address - Phone:941-794-3999
Practice Address - Fax:941-792-4048
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME11749207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059482200Medicaid
FL60060152OtherRAIL ROAD MEDICARE
FL71450OtherBCBS
FL71450TMedicare PIN
FL059482200Medicaid