Healthcare Provider Details

I. General information

NPI: 1871573246
Provider Name (Legal Business Name): FENG LIAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395
US

IV. Provider business mailing address

8620 N 22ND AVE 200
PHOENIX AZ
85021
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-1500
  • Fax:
Mailing address:
  • Phone: 602-674-6506
  • Fax: 602-674-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26187
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number26187
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: