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Organization

LU LIU FIRST ASSIST PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LU LIU PHYSICIAN ASSISTANT (SURGICAL PA-C)
(972) 264-8575
Entity
Organization

Contact information

Practice address
615 TERESA LN, GRAND PRAIRIE, TX 75052-2816
(972) 264-8575
(972) 264-8575
Mailing address
615 TERESA LN, GRAND PRAIRIE, TX 75052-2816
(972) 264-8575
(972) 264-8575

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA02204
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1093776635
INDIVIDUAL NPI NUMBER
01
187944701
INDIVIDUAL MEDICAID NUMBER
TX
01
82N820
INDIVIDUAL MEDICARE PIN NUMBER
TX
01
S60053
INDIVIDUAL MEDICARE UPIN NUMBER
TX
Enumeration date
09/25/2009
Last updated
09/25/2009
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