Healthcare Provider Details

I. General information

NPI: 1093793010
Provider Name (Legal Business Name): DAVID A LIU MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 COLLEGE DR
ROCK SPRINGS WY
82901-5863
US

IV. Provider business mailing address

PO BOX 1359
ROCK SPRINGS WY
82902-1359
US

V. Phone/Fax

Practice location:
  • Phone: 307-212-7738
  • Fax: 307-212-7786
Mailing address:
  • Phone: 307-212-7738
  • Fax: 307-212-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number44355
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number10054A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: