1174941835 NPI number — LIQIAO MA MD

Table of content: LIQIAO MA MD (NPI 1174941835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174941835 NPI number — LIQIAO MA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MA
Provider First Name:
LIQIAO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174941835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 JEFFERSON ST
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-6200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-451-0139
Provider Business Mailing Address Fax Number:
512-323-5880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5012 US HWY 75 STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75020-4610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-463-2223
Provider Business Practice Location Address Fax Number:
903-463-2224
Provider Enumeration Date:
03/31/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  269679 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NONE . This is a "NONE" identifier . This identifiers is of the category "OTHER".




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