Individual
DR. JACOB CHUA LIAO ONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1625 FOXTRAIL DR, SUITE 200, LOVELAND, CO 80538-9088
(970) 490-4209
Mailing address
1625 FOXTRAIL DR, SUITE 200, LOVELAND, CO 80538-9088
(970) 490-4209
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
37327
CO
207RI0200X
Infectious Disease Physician
Primary
37327
CO
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
37327
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025181600
—
NE
05
—
120663000
—
WY
05
—
78088577
—
CO
01
—
P00162672
MEDICARE RR
CO
Enumeration date
01/24/2006
Last updated
05/19/2016
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