Provider Demographics
NPI:1417026063
Name:DIZON, LIBERTY LIBOON (MD)
Entity Type:Individual
Prefix:DR
First Name:LIBERTY
Middle Name:LIBOON
Last Name:DIZON
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 1:10095 BEACH BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4780
Mailing Address - Country:US
Mailing Address - Phone:904-807-9112
Mailing Address - Fax:904-807-9114
Practice Address - Street 1:10095 BEACH BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4780
Practice Address - Country:US
Practice Address - Phone:904-807-9112
Practice Address - Fax:904-807-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96087208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics