Provider Demographics
NPI:1851305973
Name:LIU, JASPER ESTEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASPER
Middle Name:ESTEIN
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2486
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:600 WHITNEY RANCH DR
Practice Address - Street 2:B6
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2611
Practice Address - Country:US
Practice Address - Phone:702-547-0088
Practice Address - Fax:702-434-1579
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV12060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1851305973Medicaid
NV105404Medicare PIN
NV1851305973Medicaid
NVGA209Y (CQ328B)Medicare PIN