Provider Demographics
NPI:1922075787
Name:LIEBERMAN, ALLEN KEITH (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:KEITH
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 NORTH MD PAC EXPRESSWAY
Mailing Address - Street 2:BUILDING II SUITE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-345-7635
Mailing Address - Fax:
Practice Address - Street 1:10801 NORTH MD PAC EXPRESSWAY
Practice Address - Street 2:BUILDING II SUITE 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-345-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6157207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104397801Medicaid
742650408OtherEIN
F98238Medicare UPIN