Individual
DR. JEFFERY JOSEPH LIBRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3355 EAGLE PARK DR NE STE 103, GRAND RAPIDS, MI 49525
(616) 942-7400
(616) 942-7405
Mailing address
3355 EAGLE PARK DR NE STE 103, GRAND RAPIDS, MI 49525-7004
(616) 942-7400
(616) 942-7405
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301048963
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235131137
BCBSM - BRONSON LAKEVIEW
MI
05
—
1619009826
—
MI
05
—
2843350
—
MI
Enumeration date
03/12/2007
Last updated
06/18/2019
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