Healthcare Provider Details

I. General information

NPI: 1720073349
Provider Name (Legal Business Name): DAVID DONGJIE LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S UNIVERSITY AVE # 160
LITTLE ROCK AR
72205-5246
US

IV. Provider business mailing address

PO BOX 22389 PMB 82739
NASHVILLE TN
37202
US

V. Phone/Fax

Practice location:
  • Phone: 501-255-2482
  • Fax:
Mailing address:
  • Phone: 866-315-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberE-2195
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: