=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396487245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONNIE LIU MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2022
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11225 W GRAND PKWY S
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-8728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-674-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11511 SHADOW CREEK PKWY HR/CREDENTIALING SERVICES
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-7298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-442-0000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | V9651
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------