Provider Demographics
NPI:1184732109
Name:LIEBERSBACH, BRIAN FRANCIS (MD PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:FRANCIS
Last Name:LIEBERSBACH
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 SILVER MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-3651
Mailing Address - Country:US
Mailing Address - Phone:352-227-3095
Mailing Address - Fax:352-227-3517
Practice Address - Street 1:244 SILVER MAPLE RD
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-3651
Practice Address - Country:US
Practice Address - Phone:352-227-3095
Practice Address - Fax:352-227-3517
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264448700Medicaid
FL28063OtherBCBS
FLH66797Medicare UPIN
FLP00282921Medicare PIN
FL28063OtherBCBS
FLK9249Medicare PIN
FL28063YMedicare PIN