Provider Demographics
NPI:1811080880
Name:JAIRO D LIBREROS MD PA
Entity type:Organization
Organization Name:JAIRO D LIBREROS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:DIVINA
Authorized Official - Last Name:LIBREROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-876-7246
Mailing Address - Street 1:PO BOX 22807
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-2807
Mailing Address - Country:US
Mailing Address - Phone:813-876-7246
Mailing Address - Fax:
Practice Address - Street 1:36338 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1329
Practice Address - Country:US
Practice Address - Phone:813-876-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME639322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6408420001Medicare NSC