Provider Demographics
NPI:1043296502
Name:LIAO, LIANXI FRANK (MD)
Entity Type:Individual
Prefix:
First Name:LIANXI
Middle Name:FRANK
Last Name:LIAO
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 1:1900 MISTLETOE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4014
Mailing Address - Country:US
Mailing Address - Phone:817-338-1300
Mailing Address - Fax:817-335-9871
Practice Address - Street 1:1900 MISTLETOE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4014
Practice Address - Country:US
Practice Address - Phone:817-338-1300
Practice Address - Fax:817-335-9871
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4531207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151387102Medicaid
TX8B7722Medicare ID - Type Unspecified
TX151387102Medicaid
TX8B7722Medicare PIN