Provider Demographics
NPI:1083810089
Name:LIANG, HENRY H (DO)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:H
Last Name:LIANG
Suffix:
Gender:M
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:PO BOX 52650
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0133
Mailing Address - Country:US
Mailing Address - Phone:888-206-5902
Mailing Address - Fax:480-466-7536
Practice Address - Street 1:4825 S HIGHWAY 95 # 2-356
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426
Practice Address - Country:US
Practice Address - Phone:888-206-5902
Practice Address - Fax:480-466-7536
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1477207L00000X
CA20A10467207L00000X
MO2005017809207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1083810089Medicaid
NV1083810089Medicaid
CABM254YMedicare PIN
CABM254XMedicare PIN
NVBM254UMedicare PIN
NVBM254WMedicare PIN