Individual
DR. THOMAS F LIEB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2020 NE 61ST AVE, PORTLAND, OR 97213
(314) 402-6504
Mailing address
2020 NE 61ST AVE, PORTLAND, OR 97213-4144
(314) 402-6504
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD00021605
WA
208100000X
Physical Medicine & Rehabilitation Physician
R4N13
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136709
HEALTHLINK
MO
01
—
188614
BLUE CROSS BLUE SHIELD
MO
05
—
202879714
—
MO
01
—
21373V3223
GROUP HEATH PLAN
MO
01
—
2300462
UNITED HEALTHCARE
MO
01
—
4668145
AETNA
MO
01
—
6741899001
CIGNA
MO
01
—
P00146328
RAILROAD MEDICARE
MO
Enumeration date
06/15/2006
Last updated
08/27/2019
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