MEDICARE: DR. LIAN JEN DO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	OS7724	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	49234	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326031048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIAN JEN DO PA

Provider Business Mailing Address
First Line	:	3089 TAMIAMI TRAIL
Second Line	:	SUITE B
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952
Country	:	US
Telephone Number	:	941-627-9768
Fax Number	:	941-627-2785

Provider Business Practice Location Address
First Line	:	3089 TAMIAMI TRAIL
Second Line	:	SUITE B
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952
Country	:	US
Telephone Number	:	941-627-9768
Fax Number	:	941-627-2785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2005
Last Update Date	:	05/09/2013

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Directions to “ DR. LIAN JEN DO PA” Practice Location

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