Provider Demographics
NPI:1174708440
Name:DR DAVID LIAO ORTHOPAEDIC CENTER LLC
Entity type:Organization
Organization Name:DR DAVID LIAO ORTHOPAEDIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-454-9900
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-0935
Mailing Address - Country:US
Mailing Address - Phone:903-454-9900
Mailing Address - Fax:903-454-9909
Practice Address - Street 1:3900 JOE RAMSEY BLVD E
Practice Address - Street 2:BLDG 1
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7727
Practice Address - Country:US
Practice Address - Phone:903-454-9900
Practice Address - Fax:903-454-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4485207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161728401Medicaid
TX8J5170OtherBCBS
TXF04799OtherUPIN
TX00330VMedicare PIN