Provider Demographics
NPI:1902232408
Name:JOHN A LIEBERT, MD PC
Entity Type:Organization
Organization Name:JOHN A LIEBERT, MD PC
Other - Org Name:JOHN A LIEBERT MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:LIEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-349-0025
Mailing Address - Street 1:5450 E HIGH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5458
Mailing Address - Country:US
Mailing Address - Phone:602-349-0025
Mailing Address - Fax:480-502-9465
Practice Address - Street 1:5450 E HIGH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5458
Practice Address - Country:US
Practice Address - Phone:602-349-0025
Practice Address - Fax:480-502-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ243782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty