Provider Demographics
NPI:1538134408
Name:LIEBERMAN, JON F (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:F
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 30TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:907-456-3100
Mailing Address - Fax:907-456-3141
Practice Address - Street 1:1626 30TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-456-3100
Practice Address - Fax:907-456-3141
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK2658208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1007885Medicaid
AKMD0230Medicaid
AKF08789Medicare UPIN
AKMD0230Medicaid