Provider Demographics
NPI:1700999141
Name:LIAO, DAVID Y (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:Y
Last Name:LIAO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 JOE RAMSEY BLVD E STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7856
Mailing Address - Country:US
Mailing Address - Phone:903-408-7768
Mailing Address - Fax:903-408-7769
Practice Address - Street 1:4211 JOE RAMSEY BLVD E STE E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7852
Practice Address - Country:US
Practice Address - Phone:903-408-7768
Practice Address - Fax:903-408-7769
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4485207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J5170OtherBCBS
TX161728401Medicaid
TX161728401Medicaid
TX8A7762Medicare ID - Type Unspecified