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Individual

R SCOTT LIEBL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
835 S MAIN ST, SUITE 1, OCONTO FALLS, WI 54154-1241
(920) 846-8424
(920) 846-2073
Mailing address
835 S MAIN ST, SUITE 1, OCONTO FALLS, WI 54154-1241
(920) 846-8424
(920) 846-2073

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
21763020
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
11014110
WI
01
1851477913
NPI
05
30189000
WI
01
390848401050
BXBS
WI
Enumeration date
10/03/2005
Last updated
09/02/2014
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