MEDICARE: LIANCUN WU

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	207L00000X	Anesthesiology Physician	L3195	TX

General Provider Information

NPI Number	:	1649270109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANCUN WU

Provider Business Mailing Address
First Line	:	1500 S MAIN ST
Second Line	:	JPS HOSIPITAL, DEPARTMENT OF ANESTHESIOLOGY
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S MAIN ST
Second Line	:	JPS HOSIPITAL, DEPARTMENT OF ANESTHESIOLOGY
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4917
Country	:	US
Telephone Number	:	817-927-1417
Fax Number	:

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	07/11/2007

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Directions to “ LIANCUN WU ” Practice Location

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