Provider Demographics
NPI:1144693995
Name:LEIBRECHT MD, MURL E
Entity type:Organization
Organization Name:LEIBRECHT MD, MURL E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MURL
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:LEIBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-631-5355
Mailing Address - Street 1:578 MICHAEL WAY
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-8464
Mailing Address - Country:US
Mailing Address - Phone:360-631-5355
Mailing Address - Fax:
Practice Address - Street 1:578 MICHAEL WAY
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-8464
Practice Address - Country:US
Practice Address - Phone:360-631-5355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00015522261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center