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Organization
LIBERTY HEALTHCARE LLC
Active
Organization
LIBERTY HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERK PARDOE (PARTNER)
(801) 808-2357
Entity
Organization
Contact information
Practice address
5589 GREENWICH RD, SUITE 175, VIRGINIA BEACH, VA 23462-6565
(757) 216-9115
(757) 216-9117
Mailing address
3454 E STONE MOUNTAIN LN, SANDY, UT 84092-6549
(801) 808-2357
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
140177
VA
Other
Enumeration date
11/05/2012
Last updated
11/05/2012
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