Individual
LIANA H PROFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1611 WALLACE BLVD, AMARILLO, TX 79106-1799
(806) 354-4900
(806) 352-4987
Mailing address
1611 WALLACE BLVD, AMARILLO, TX 79106-1799
(806) 354-4900
(806) 352-4987
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
K6910
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187150101
—
TX
01
—
8V1240
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/09/2005
Last updated
02/10/2014
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