Provider Demographics
NPI:1063407724
Name:LIEBERFARB, MARK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:LIEBERFARB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6894 LAKE WORTH RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2964
Mailing Address - Country:US
Mailing Address - Phone:561-641-4044
Mailing Address - Fax:561-641-8524
Practice Address - Street 1:6894 LAKE WORTH RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2964
Practice Address - Country:US
Practice Address - Phone:561-641-4044
Practice Address - Fax:561-641-8524
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2012-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0048840208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07451Medicare ID - Type Unspecified
FLD21223Medicare UPIN