Jon F Lieberman, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

2658 Issued in AK

Practice address

1626 30TH Ave
Suite 201
Fairbanks, AK 99701

Phone

(907) 456-3100

Fax

(907) 456-3141

NPI assigned

Feb 22, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fairbanks Surgery, LLC

  • Surgery Physician
  • Fairbanks, AK
  • NPI 1790017291
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395619200000",
    "number": "1538134408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 30TH AVE",
            "address_2": "SUITE 201",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99701",
            "telephone_number": "907-456-3100",
            "fax_number": "907-456-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 30TH AVE",
            "address_2": "SUITE 201",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99701",
            "telephone_number": "907-456-3100",
            "fax_number": "907-456-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "JON",
        "middle_name": "F",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2014-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AK",
            "license": "2658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007885",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD0230",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pauline Lian, B.A.
• Morgan Birrell Liddell, MD
• Tanesha Michele Lie
• Gwendolyn Z Lieb, M.D.
• Madeline Lieb
• Life Sprout Chiropractic LLC
• Derika Life
• Lifeologist Wellness & Educational Consultant
• Lifetothefullestllc
• Anne Marie Lilley, RN, MSN, FNP

• Surgery Physician in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Surgery Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.