Provider Demographics
NPI:1548209075
Name:LIAO, STEPHEN K (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:LIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6241 N PLACITA DE LUIS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2736
Mailing Address - Country:US
Mailing Address - Phone:520-544-5178
Mailing Address - Fax:
Practice Address - Street 1:2181 W ORANGE GROVE RD
Practice Address - Street 2:#185
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3118
Practice Address - Country:US
Practice Address - Phone:520-575-5766
Practice Address - Fax:520-575-5593
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ24064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53250Medicare UPIN