Healthcare Provider Details

I. General information

NPI: 1306335047
Provider Name (Legal Business Name): ALEX LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 S ROME ST STE 209
GILBERT AZ
85297-7338
US

IV. Provider business mailing address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5452
US

V. Phone/Fax

Practice location:
  • Phone: 623-238-7370
  • Fax: 480-821-0950
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number59303
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: