Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 25912 | AL |
Y | 207RH0003X | Hematology & Oncology | 32590 | AZ |
N | 207RH0003X | Hematology & Oncology | P0083 | TX |
N | 207RX0202X | Medical Oncology | 25912 | AL |
NPI | 1043477441 |
---|---|
Provider Name | Theresa Ong Liu Dumlao |
First Address | Gilbert, AZ 85234-2165 |
Second Address | Gilbert, AZ 85234-2165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 15/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04101524 | (05) | MS |
139243 | (05) | AL |
287754001 (MDACC) | (05) | TX |
51591744 | BCBS - 1 INFIRMARY CIRCLE (01) | AL |
8DC007 | BCBS (MDACC) (01) | TX |
I12176 | (02) | AL |