Provider Demographics
NPI:1740592849
Name:LIEBERTZ, DANIEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:LIEBERTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5209 LAKE WASHINGTON BLVD NE
Mailing Address - Street 2:STE 115
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7355
Mailing Address - Country:US
Mailing Address - Phone:425-822-0300
Mailing Address - Fax:425-822-4999
Practice Address - Street 1:5209 LAKE WASHINGTON BLVD NE
Practice Address - Street 2:STE 115
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7355
Practice Address - Country:US
Practice Address - Phone:425-822-0300
Practice Address - Fax:425-822-4999
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA073020207YS0123X
WA60671191207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery