Provider Demographics
NPI:1063427938
Name:STEVEN J LIEBERSON DPM, PC
Entity type:Organization
Organization Name:STEVEN J LIEBERSON DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIEBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-242-3233
Mailing Address - Street 1:PO BOX 16729
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6729
Mailing Address - Country:US
Mailing Address - Phone:281-242-3233
Mailing Address - Fax:713-654-7095
Practice Address - Street 1:4780 SWEETWATER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3163
Practice Address - Country:US
Practice Address - Phone:281-242-3233
Practice Address - Fax:713-654-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018766801Medicaid
TXT15908Medicare UPIN
TX0287250001Medicare NSC
TX018766801Medicaid