Healthcare Provider Details

I. General information

NPI: 1841278595
Provider Name (Legal Business Name): ROGER T LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 114TH ST SUITE 347
DES MOINES IA
50324-7046
US

IV. Provider business mailing address

1601 NW 114TH ST SUITE 347
DES MOINES IA
50324-7046
US

V. Phone/Fax

Practice location:
  • Phone: 515-224-1777
  • Fax: 515-222-0226
Mailing address:
  • Phone: 515-224-1777
  • Fax: 515-222-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number21030
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number21030
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number21030
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: