Provider Demographics
NPI:1003235250
Name:LIANG, JASON (DPM)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:LIANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 100
Mailing Address - Street 2:DEPT #460
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-0100
Mailing Address - Country:US
Mailing Address - Phone:918-494-2955
Mailing Address - Fax:918-301-0088
Practice Address - Street 1:3627 S. HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-747-4855
Practice Address - Fax:918-747-4866
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005765213E00000X
IN41000307A213ES0103X
IL016.005765213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist