Provider Demographics
NPI:1477573350
Name:LIEBERSON, STEVEN JEFFERY (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JEFFERY
Last Name:LIEBERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 ST JOSEPH PKWY STE 1002
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8231
Mailing Address - Country:US
Mailing Address - Phone:713-654-1955
Mailing Address - Fax:713-654-7095
Practice Address - Street 1:4780 SWEETWATER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3163
Practice Address - Country:US
Practice Address - Phone:281-242-0323
Practice Address - Fax:713-654-7095
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1386213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018572001Medicaid
TX00103EMedicare ID - Type Unspecified
TXU70502Medicare UPIN
TX6402440001Medicare NSC
TX018572001Medicaid