Individual
KEITH A. LEIBOWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 17TH ST STE 102, MODESTO, CA 95354-1248
(209) 522-6100
(209) 522-6110
Mailing address
4120 DALE RD., SUITE J8-240, MODESTO, CA 95356
(209) 522-6100
(209) 522-6110
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
0101239026
VA
207RG0100X
Gastroenterology Physician
Primary
G129017
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010251338
—
VA
01
—
192063
ANTHEM
VA
01
—
P00313962
RR/MEDICARE
—
Enumeration date
02/21/2006
Last updated
05/31/2022
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