Provider Demographics
NPI:1801892633
Name:LIEBOWITZ, FRED A (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:A
Last Name:LIEBOWITZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:6150 DIAMOND CENTRE CT
Mailing Address - Street 2:# 700-1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4365
Mailing Address - Country:US
Mailing Address - Phone:239-278-1000
Mailing Address - Fax:239-278-0501
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:# 700-1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4365
Practice Address - Country:US
Practice Address - Phone:239-278-1000
Practice Address - Fax:239-278-0501
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME60344207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE99000Medicare UPIN
FLE99000Medicare UPIN