Provider Demographics
NPI:1225047657
Name:LIAO, LIXIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LIXIN
Middle Name:
Last Name:LIAO
Suffix:
Gender:M
Credentials:MD, PHD
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:515 W MAYFIELD RD
Practice Address - Street 2:#101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2083
Practice Address - Country:US
Practice Address - Phone:817-467-6092
Practice Address - Fax:817-465-0680
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9322207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166665301Medicaid
TX8R1493OtherBLUE CROSS OF TX
TX166665302Medicaid
TX166665303Medicaid
TX8R1493OtherBLUE CROSS OF TX
TX166665303Medicaid
TX412019YKYCMedicare PIN
TX166665301Medicaid
TX8C1394Medicare PIN