Provider Demographics
NPI:1407893001
Name:LIEM, CALEB (MD)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:
Last Name:LIEM
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:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668
Mailing Address - Country:US
Mailing Address - Phone:360-514-7550
Mailing Address - Fax:360-514-7553
Practice Address - Street 1:8716 E MILL PLAIN BLVD
Practice Address - Street 2:RELIEF POSITION ONLY
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98668
Practice Address - Country:US
Practice Address - Phone:360-514-7550
Practice Address - Fax:360-514-7553
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030554207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1087873Medicaid
WAG8856020Medicare ID - Type Unspecified
WA1087873Medicaid