Provider Demographics
NPI:1003886409
Name:LIU, JEAN H (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:H
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3824
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-2413
Practice Address - Street 1:1139 E SONTERRA BLVD STE 520
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4347
Practice Address - Country:US
Practice Address - Phone:210-490-6000
Practice Address - Fax:210-490-4658
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4988207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CM508OtherBCBS
TX124300806Medicaid
TXTXB112504OtherMEDICARE
TXP00898257OtherRAILROAD MEDICARE
TX8CM508OtherBCBS
TX80867FMedicare ID - Type UnspecifiedMEIDCARE
TXB112504Medicare PIN
TXB112504Medicare PIN