Healthcare Provider Details

I. General information

NPI: 1891292140
Provider Name (Legal Business Name): XIAOLONG LIU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E JACKSON AVE
JONESBORO AR
72401-3119
US

IV. Provider business mailing address

225 E JACKSON AVE
JONESBORO AR
72401-3119
US

V. Phone/Fax

Practice location:
  • Phone: 870-207-7300
  • Fax:
Mailing address:
  • Phone: 870-207-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-13532
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: