Provider Demographics
NPI:1588851562
Name:BRIAN F LIEBERSBACH MD PHD PA
Entity Type:Organization
Organization Name:BRIAN F LIEBERSBACH MD PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LIEBERSBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-383-6184
Mailing Address - Street 1:19333 SPRING OAK DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-7214
Mailing Address - Country:US
Mailing Address - Phone:352-589-0305
Mailing Address - Fax:352-589-0305
Practice Address - Street 1:19333 SPRING OAK DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-7214
Practice Address - Country:US
Practice Address - Phone:352-589-0305
Practice Address - Fax:352-589-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9249Medicare PIN
FLDE2813Medicare PIN
FLP00282921Medicare PIN