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General NPI Number Information
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NPI Number | 1851360796
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Entity Type | Individual
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Provider Name | VIC LIENGSWANGWONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 1751 VETERANS DR
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City | FLORENCE
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State | AL
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Zip | 35630-4929
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Country | US
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Telephone | 256-629-4800
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Fax | 256-629-4899
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Provider Business Mailing Address
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Address Line | 1701 VETERANS DR STE 190
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City | FLORENCE
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State | AL
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Zip | 35630-4928
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Country | US
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Telephone | 256-629-4800
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Fax | 256-629-4899
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 34883
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 63950-20
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License Number State | WI
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