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General NPI Number Information
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NPI Number | 1184087611
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Entity Type | Organization
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Legal Business Name | JEFFREY TA LIU MD LLC
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 3040 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-1944
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Country | US
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Telephone | 702-477-0707
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Fax | 702-207-4972
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Provider Business Mailing Address
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Address Line | 3040 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-1944
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Country | US
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Telephone | 702-477-0707
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Fax | 702-207-4972
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Authorized Official
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Title or Position | PROVIDER
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Name | JEFFREY TA LIU
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Credential | MD
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Telephone | 702-477-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 7490
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License Number State | NV
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