Provider Demographics
NPI:1528096989
Name:LIBLING, ELLIOT MARTIN (MD)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:MARTIN
Last Name:LIBLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 N 64TH DR
Mailing Address - Street 2:STE 312
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7114
Mailing Address - Country:US
Mailing Address - Phone:623-566-4718
Mailing Address - Fax:623-566-4820
Practice Address - Street 1:18700 N 64TH DR
Practice Address - Street 2:STE 312
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7114
Practice Address - Country:US
Practice Address - Phone:623-566-4718
Practice Address - Fax:623-566-4820
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20805207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ122838001Medicaid
F46555Medicare UPIN