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General NPI Number Information
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NPI Number | 1417605684
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Entity Type | Individual
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Provider Name | GUYU LIU MD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 280 DAVID L GOLDFEIN ST BLDG 23
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City | HOLLOMAN AFB
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State | NM
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Zip | 88330-8273
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Country | US
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Telephone | 575-572-0723
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Fax |
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Provider Business Mailing Address
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Address Line | 280 DAVID L GOLDFEIN ST BLDG 23
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City | HOLLOMAN AIR FORCE BASE
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State | NM
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Zip | 88330-8273
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Country | US
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Telephone | 575-572-0723
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Fax | 575-572-3182
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101279842
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License Number State | VA
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