Basic Information
| Provider Information | |||||||||
| NPI: | 1609859982 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIEBERMAN | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7912 E 31ST CT | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741451315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187438200 | ||||||||
| FaxNumber: | 9187438609 | ||||||||
| Practice Location | |||||||||
| Address1: | 7912 E 31ST CT | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741451315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187438200 | ||||||||
| FaxNumber: | 9187438609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 05/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301066428 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.