Provider Demographics
NPI:1093776635
Name:LIU, LU (PA)
Entity Type:Individual
Prefix:
First Name:LU
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10140 ESTATE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2135
Mailing Address - Country:US
Mailing Address - Phone:214-345-5756
Mailing Address - Fax:214-345-1452
Practice Address - Street 1:10140 ESTATE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2135
Practice Address - Country:US
Practice Address - Phone:214-345-5756
Practice Address - Fax:214-345-1452
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02204363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187944701Medicaid
TX187944701Medicaid
TX82N820Medicare PIN