Provider Demographics
NPI:1336328202
Name:LIU, WEN (MD)
Entity Type:Individual
Prefix:DR
First Name:WEN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 880
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-798-3328
Mailing Address - Fax:318-798-9729
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 880
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-798-3328
Practice Address - Fax:318-798-9729
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA025210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1433110Medicaid
LA4J380Medicare PIN
LAH24378Medicare UPIN
LA1433110Medicaid