Provider Demographics
NPI:1366649253
Name:LIEBMANN, STEPHANIE ERICA (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ERICA
Last Name:LIEBMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:629-224-1616
Mailing Address - Fax:
Practice Address - Street 1:1315 AUBERT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-1918
Practice Address - Country:US
Practice Address - Phone:314-449-9726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01081401OtherRAILROAD MEDICARE
MO1366649253Medicaid
MOP01081401OtherRAILROAD MEDICARE