=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952502759
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WINSTON R LIAW MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2007
-----------------------------------------------------
Last Update Date | 08/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4349 MARTIN LUTHER KING BLVD HEALTH 2 BLDG SUITE 1001E
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77204-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-743-9682
-----------------------------------------------------
Fax | 713-743-1049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 E UNIVERSITY AVE STE 200
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78626-6821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-686-0207
-----------------------------------------------------
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 | 0116018399
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | R2908
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------