Provider Demographics
NPI:1184605867
Name:LIEBERFARB, MARSHAL E (MD)
Entity type:Individual
Prefix:
First Name:MARSHAL
Middle Name:E
Last Name:LIEBERFARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:350 NW 84TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1817
Practice Address - Country:US
Practice Address - Phone:954-370-7555
Practice Address - Fax:954-370-7554
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00875412085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL293997OtherAMERIGROUP PROVIDER NUM.
FL71895OtherBCBS PROVIDER NUMBER
FLQMP000003703687OtherMOLINA MCD
FLQMP000003845027OtherMOLINA MCR
FL4099435OtherGHI PROVIDER NUMBER
FLP0003155OtherFLORIDA HEALTHCARE PLUS
FL53622OtherNHP THRU PMG PROVIDER #
FL7202545OtherAETNA PROVIDER NUMBER
FL10472OtherDIMENSION PROVIDER NUMBER
FL325347OtherWELLCARE PROVIDER NUMBER
FLP00405311OtherRAILROAD MEDICARE
FL290543OtherAVMED PROVIDER NUMBER
FL267415700Medicaid
FL5654949OtherFIRST HEALTH PROVIDER #
FL53622OtherNHP THRU PMG PROVIDER #
FLQMP000003703687OtherMOLINA MCD
H92827Medicare UPIN