Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 35132 | AZ |
Y | 207RP1001X | Pulmonary Disease | 35132 | AZ |
NPI | 1053379263 |
---|---|
Provider Name | Dr. Da-Wei Liao |
First Address | Mesa, AZ 85206-1346 |
Second Address | Phoenix, AZ 85032-2158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 10/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151680 | (05) | AZ |
35132 | AZ MD LIC (01) | AZ |
H84229 | (02) | |
H84229 | (02) | AZ |
Z117914 | MEDICARE (01) | AZ |