Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5015 | AL |
NPI | 1114092442 |
---|---|
Provider Name | Dr. Perng-Ru Liu |
First Address | Birmingham, AL 35216 |
Second Address | Birmingham, AL 35216-3116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |