Healthcare Provider Details

I. General information

NPI: 1710920038
Provider Name (Legal Business Name): ALEXANDER ONG LIU JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WEST LEMON STREET
BEVERLY HILLS FL
34465
US

IV. Provider business mailing address

PO BOX 640524
BEVERLY HILLS FL
34464-0524
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-2525
  • Fax: 352-746-4141
Mailing address:
  • Phone: 352-746-2525
  • Fax: 352-746-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0071491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: