Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 016005765 | IL |
N | 222Z00000X | Podiatrist | 016005765 | IL |
Y | 213ES0103X | Foot & Ankle Surgery | 016.005765 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 41000307A | IN |
NPI | 1003235250 |
---|---|
Provider Name | Dr. Jason Liang |
First Address | Carbondale, IL 62902-3988 |
Second Address | Murphysboro, IL 62966-7072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 05/03/2021 |