Provider Demographics
NPI:1407864143
Name:LIEBERMAN, DEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 S CONGRESS AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1139
Mailing Address - Country:US
Mailing Address - Phone:561-433-4444
Mailing Address - Fax:
Practice Address - Street 1:5507 S CONGRESS AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1139
Practice Address - Country:US
Practice Address - Phone:561-433-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9100994363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290660100Medicaid
FLE2879SMedicare PIN
FLP00683792Medicare PIN