Provider Demographics
NPI:1093793010
Name:LIU, DAVID A (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:LIU
Suffix:
Gender:M
Credentials:MD, DDS
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 1359
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1359
Mailing Address - Country:US
Mailing Address - Phone:307-212-7738
Mailing Address - Fax:307-212-7786
Practice Address - Street 1:1180 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5863
Practice Address - Country:US
Practice Address - Phone:307-212-7738
Practice Address - Fax:307-212-7786
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44355207Y00000X
WY10054A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1652661OtherAMERICAS PPO
IA6129536Medicaid
040017466OtherRR MEDICARE
MN1000323OtherMEDICA
MN40M40LIOtherBCBS
MN141284OtherUCARE
MN579112000Medicaid
MNHP37497OtherHEALTH PARTNERS
MNNA2951029064OtherPREFERRED ONE
MNHP37497OtherHEALTH PARTNERS
MN40M40LIOtherBCBS