Provider Demographics
NPI:1982895801
Name:LIU, SUE MAY (MD)
Entity Type:Individual
Prefix:
First Name:SUE MAY
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 BARNEY RUSH RD
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-9430
Mailing Address - Country:US
Mailing Address - Phone:318-466-5864
Mailing Address - Fax:
Practice Address - Street 1:96 BARNEY RUSH RD
Practice Address - Street 2:
Practice Address - City:DEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71328-9430
Practice Address - Country:US
Practice Address - Phone:318-466-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.05814R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1327581Medicaid