Provider Demographics
NPI:1174724769
Name:BARRY J LIBERONI, MD PA
Entity type:Organization
Organization Name:BARRY J LIBERONI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-245-9797
Mailing Address - Street 1:720 AVENUE F N
Mailing Address - Street 2:STE. 3
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-9573
Mailing Address - Country:US
Mailing Address - Phone:979-245-9797
Mailing Address - Fax:979-245-9789
Practice Address - Street 1:720 AVENUE F N
Practice Address - Street 2:STE. 3
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-9573
Practice Address - Country:US
Practice Address - Phone:979-245-9797
Practice Address - Fax:979-245-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2023855Medicaid
TX2023855Medicaid