Provider Demographics
NPI:1518971027
Name:LIU, JIANGPING (MD)
Entity Type:Individual
Prefix:
First Name:JIANGPING
Middle Name:
Last Name:LIU
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:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-924-6201
Practice Address - Street 1:1307 8TH AVE
Practice Address - Street 2:STE 610
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4142
Practice Address - Country:US
Practice Address - Phone:817-924-6200
Practice Address - Fax:817-924-6201
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL40422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130026309OtherRAILROAD MEDICARE
TX155138401Medicaid