Provider Demographics
NPI:1841306925
Name:LIEBERMAN, STEPHEN FARRELL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FARRELL
Last Name:LIEBERMAN
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 1:14430 PFEIFER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2408
Mailing Address - Country:US
Mailing Address - Phone:503-635-3141
Mailing Address - Fax:503-635-1225
Practice Address - Street 1:10100 SE SUNNYSIDE RD
Practice Address - Street 2:MT TALBERT MEDICAL OFFICE
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-571-3787
Practice Address - Fax:503-571-3772
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11245208800000X
WAMD00034645208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology