Provider Demographics
NPI:1467523365
Name:LIEB, JOHN G II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:LIEB
Suffix:II
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 1:1600 SW ARCHER RD BOX 100214
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0214
Mailing Address - Country:US
Mailing Address - Phone:352-392-2877
Mailing Address - Fax:352-392-3618
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-4238
Practice Address - Country:US
Practice Address - Phone:352-392-2877
Practice Address - Fax:352-392-3618
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428599207RG0100X
FLME101188207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105238400Medicaid
AL050ZMedicare PIN