Basic Information
| Provider Information | |||||||||
| NPI: | 1396935813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | LIAT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 W GANDY BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336112931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139251903 | ||||||||
| FaxNumber: | 8137498370 | ||||||||
| Practice Location | |||||||||
| Address1: | 11969 SHELDON RD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336263644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139251903 | ||||||||
| FaxNumber: | 8137498370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2007 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME99123 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.