Active NPI
Jeffrey Stephen Liebo, M.D.
- Pediatrics Physician
- Clackamas, OR
National Provider Identifier
1831132414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 16716
- Practice address
- 9980 SE Sunnyside Rd
Clackamas, OR 97015-9764 - Phone
- (503) 813-0378
- NPI assigned
- Jun 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 16716 | OR | Primary |
Addresses
Primary practice location
9980 SE Sunnyside Rd
Clackamas, OR 97015-9764
Mailing address
9800 SE Sunnyside Rd
Clackamas, OR 97015-9750
Phone (503) 813-0378
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16716 | OR | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1831132414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9800 SE SUNNYSIDE RD",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970159750",
"telephone_number": "503-813-0378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9980 SE SUNNYSIDE RD",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970159764",
"telephone_number": "503-813-0378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBO",
"first_name": "JEFFREY",
"middle_name": "STEPHEN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-13",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "16716",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clackamas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.