MEDICARE: JEFFREY TA LIU MD - LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	7490	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	80-0551016	OTHER	NV	TAX IDENTIFICATION
3	CS7890	OTHER	NV	NEVADA PHARMACY

General Provider Information

NPI Number	:	1023051117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY TA LIU MD - LLC

Provider Business Mailing Address
First Line	:	3040 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1944
Country	:	US
Telephone Number	:	702-477-0707
Fax Number	:	888-232-5937

Provider Business Practice Location Address
First Line	:	3040 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1944
Country	:	US
Telephone Number	:	702-477-0707
Fax Number	:	888-232-5937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	03/07/2023

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Directions to “ JEFFREY TA LIU MD - LLC” Practice Location

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