Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 7490 | NV |
NPI | 1023051117 |
---|---|
Provider Name | Jeffrey Ta Liu |
First Address | Las Vegas, NV 89102-1944 |
Second Address | Las Vegas, NV 89102-1944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 01/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2019887 | (05) | NV |
80-0551016 | TAX IDENTIFICATION (01) | NV |
BL4602202 | DEA (01) | NV |
CS7890 | NEVADA PHARMACY (01) | NV |
G28701 | (02) | NV |