Basic Information
| Provider Information | |||||||||
| NPI: | 1356723944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIEBEL | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 E GOLDSTONE DR | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836421026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083029342 | ||||||||
| FaxNumber: | 2083675180 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 N CURTIS RD STE 415 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837061334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083022600 | ||||||||
| FaxNumber: | 2083022625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2015 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | M-16663 | ID | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 208600000X | R3837 | KY | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 53908 | KY | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.