Provider Demographics
NPI:1073544466
Name:LIU, REN-CHANG (MD)
Entity Type:Individual
Prefix:
First Name:REN-CHANG
Middle Name:
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 1:3146 COUNTRY CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5731
Mailing Address - Country:US
Mailing Address - Phone:904-272-2240
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214
Practice Address - Country:US
Practice Address - Phone:904-542-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME275252085R0202X
WV186872085R0202X
VA01010318372085R0202X
OK125512085R0202X
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology