Provider Demographics
NPI:1639732126
Name:LIBBY, ADAM BENJAMIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:BENJAMIN
Last Name:LIBBY
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 1:7878 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2307
Mailing Address - Country:US
Mailing Address - Phone:901-428-6823
Mailing Address - Fax:901-756-4413
Practice Address - Street 1:7878 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2307
Practice Address - Country:US
Practice Address - Phone:901-757-0046
Practice Address - Fax:901-756-4413
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN927213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery