Provider Demographics
NPI:1932218179
Name:LIEBER, GARY ARTHUR (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ARTHUR
Last Name:LIEBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 CLINT MOORE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2768
Mailing Address - Country:US
Mailing Address - Phone:561-995-0229
Mailing Address - Fax:561-989-0775
Practice Address - Street 1:1601 CLINT MOORE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2768
Practice Address - Country:US
Practice Address - Phone:561-995-0229
Practice Address - Fax:561-989-0775
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1448213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1285090001Medicare NSC
FL87756Medicare PIN
FLT55533Medicare UPIN