Healthcare Provider Details

I. General information

NPI: 1992782403
Provider Name (Legal Business Name): XIAOLONG SEAN LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD
GAINESVILLE FL
32605
US

IV. Provider business mailing address

PO BOX 741087
ATLANTA GA
30384-1087
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4955
  • Fax: 352-333-4284
Mailing address:
  • Phone: 352-333-4955
  • Fax: 352-333-4284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD20050608
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberMD20050608
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License NumberMD20050608
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD20050608
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME128535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: