Provider Demographics
NPI:1437155751
Name:LIANG, JEFFREY E (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:LIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4103
Mailing Address - Country:US
Mailing Address - Phone:817-370-6350
Mailing Address - Fax:
Practice Address - Street 1:6001 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4103
Practice Address - Country:US
Practice Address - Phone:817-370-6350
Practice Address - Fax:817-370-6401
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4530207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7783411OtherAETNA PPO
TX161325902Medicaid
TX250013603OtherRR MEDICARE NUMBER
TX8H9350OtherBC/BS
TX198468OtherAMERIGROUP
TX161325904Medicaid
TX7783411OtherAETNA HMO
TX161325903Medicaid
TX161325901Medicaid
TXL4530OtherSTATE LICENSE
TXP01084630OtherRAILROAD
TXH59750Medicare UPIN
TX161325904Medicaid
TX250013603OtherRR MEDICARE NUMBER
TX7783411OtherAETNA HMO
TX7783411OtherAETNA PPO