Provider Demographics
NPI:1740245034
Name:LEIB, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:LEIB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9500 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9349
Mailing Address - Country:US
Mailing Address - Phone:831-336-3200
Mailing Address - Fax:831-336-3203
Practice Address - Street 1:6222 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9713
Practice Address - Country:US
Practice Address - Phone:831-335-9141
Practice Address - Fax:831-335-1341
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00G416080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48629Medicare UPIN
OOG416080Medicare ID - Type Unspecified