Provider Demographics
NPI:1487630349
Name:LIEBERMAN, DONALD CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CHARLES
Last Name:LIEBERMAN
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 1:1331 ST TROPEZ CIR
Mailing Address - Street 2:#606
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3020
Mailing Address - Country:US
Mailing Address - Phone:561-504-0025
Mailing Address - Fax:
Practice Address - Street 1:1331 ST TROPEZ CIR
Practice Address - Street 2:#606
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3020
Practice Address - Country:US
Practice Address - Phone:561-504-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD71668Medicare UPIN
FLU5905ZMedicare ID - Type Unspecified