Organization
LU LIU FIRST ASSIST PLLC
Active
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
Update your record
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