MEDICARE: 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	OS09374	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49234	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1588762058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	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	:	PHYSICIAN
Name	:	DR. LIAN JEN
Credential	:	DO PA
Telephone Number	:	941-627-9768

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/07/2008

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Directions to “LIAN JEN DO PA ” Practice Location

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