Provider Demographics
NPI:1437101904
Name:LIBERMAN, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-348-4123
Practice Address - Fax:239-348-4035
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLFLME0078783208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00921458OtherRAILROAD MEDICARE
FLP202313OtherOPTIMUM
FL061640OtherWELLCARE
FL3314810OtherCIGNA
FL10M009OtherHEALTHY KIDS PROGRAM THRU COMMUNITY HEALTH PARTNERS, PHO
FL115988OtherUNIVERSAL
FL256953100Medicaid
FL4579508OtherAETNA
FL308519OtherAVMED
FLP307258OtherFREEDOM HEALTH
FL47076WMedicare PIN
FLF76803Medicare UPIN
FL47076XMedicare PIN