Provider Demographics
NPI:1033165634
Name:LIU, NADINE (DO)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 TOEPPERWEIN RD
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3161
Mailing Address - Country:US
Mailing Address - Phone:210-599-3840
Mailing Address - Fax:210-599-1713
Practice Address - Street 1:11901 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 1402
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3161
Practice Address - Country:US
Practice Address - Phone:210-599-3840
Practice Address - Fax:210-599-1713
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8301207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF7295Medicare UPIN
TXF7295Medicare UPIN