Healthcare Provider Details

I. General information

NPI: 1003886409
Provider Name (Legal Business Name): JEAN H LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 E SONTERRA BLVD STE 520
SAN ANTONIO TX
78258-4347
US

IV. Provider business mailing address

4411 MEDICAL DR STE 300
SAN ANTONIO TX
78229-3824
US

V. Phone/Fax

Practice location:
  • Phone: 210-490-6000
  • Fax: 210-490-4658
Mailing address:
  • Phone: 210-614-5400
  • Fax: 210-614-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberH4988
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: