Provider Demographics
NPI:1588851562
Name:BRIAN F LIEBERSBACH MD PHD PA
Entity type:Organization
Organization Name:BRIAN F LIEBERSBACH MD PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LIEBERSBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-561-4715
Mailing Address - Street 1:1051 VANCE TRL
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-8719
Mailing Address - Country:US
Mailing Address - Phone:352-561-4715
Mailing Address - Fax:352-561-4376
Practice Address - Street 1:1051 VANCE TRL
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-8719
Practice Address - Country:US
Practice Address - Phone:352-561-4715
Practice Address - Fax:352-561-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes315D00000XNursing & Custodial Care FacilitiesHospice, InpatientGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9249Medicare PIN
FLDE2813Medicare PIN
FLP00282921Medicare PIN