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General NPI Number Information
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NPI Number | 1134706989
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Entity Type | Individual
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Provider Name | GARY LIU MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 4100 W KENNEDY BLVD STE 303
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City | TAMPA
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State | FL
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Zip | 33609-2257
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Country | US
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Telephone | 813-419-2067
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Fax |
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Provider Business Mailing Address
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Address Line | 3512 W OBISPO ST
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City | TAMPA
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State | FL
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Zip | 33629-7917
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Country | US
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Telephone | 813-419-2067
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Fax | 305-703-6558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME173028
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD481609
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License Number State | PA
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