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General NPI Number Information
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NPI Number | 1346055134
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Entity Type | Individual
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Provider Name | BRIAN NEIL LIAO
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Gender | Male
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 17 DAVIS BLVD STE 308
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City | TAMPA
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State | FL
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Zip | 33606-3438
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Country | US
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Telephone | 813-250-2506
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Fax |
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Provider Business Mailing Address
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Address Line | 6612 SAHALEE DR
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City | FORT WORTH
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State | TX
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Zip | 76132-4508
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Country | US
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Telephone | 817-223-8176
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Fax |
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 47194
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License Number State | FL
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