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General NPI Number Information
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NPI Number | 1194184861
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Entity Type | Organization
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Legal Business Name | JIMMY LIU, M.D., P.A.
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 24301 WALDEN CENTER DR STE 300
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4965
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Country | US
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Telephone | 239-345-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 21301 S TAMIAMI TRL SUITE 320 PMB 222
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City | ESTERO
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State | FL
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Zip | 33928-2942
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Country | US
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Telephone | 239-345-8001
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Fax |
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Authorized Official
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Title or Position | OWNER, MD
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Name | JIMMY CHENG-YI LIU
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Credential | MD
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Telephone | 724-759-9819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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