Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MT201794 | PA |
NPI | 1003179078 |
---|---|
Provider Name | Dr. Gordon Liu |
First Address | Mckeesport, PA 15132-1126 |
Second Address | Mckeesport, PA 15132-1126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2012 |
Last Update Date | 24/06/2012 |