Provider Demographics
NPI:1285822999
Name:LIU, SHAI YUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAI
Middle Name:YUAN
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S
Other - Middle Name:Y
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:318 N ALLEGHANEY AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5081
Mailing Address - Country:US
Mailing Address - Phone:432-333-2878
Mailing Address - Fax:432-333-2882
Practice Address - Street 1:318 N ALLEGHANEY AVE
Practice Address - Street 2:STE 301
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5081
Practice Address - Country:US
Practice Address - Phone:432-333-2878
Practice Address - Fax:432-333-2882
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3048208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD66821Medicare UPIN