Provider Demographics
NPI:1891770046
Name:PROFFER, LIANA H (MD)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:H
Last Name:PROFFER
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 1:1611 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1799
Mailing Address - Country:US
Mailing Address - Phone:806-354-4900
Mailing Address - Fax:806-352-4987
Practice Address - Street 1:1611 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1799
Practice Address - Country:US
Practice Address - Phone:806-354-4900
Practice Address - Fax:806-352-4987
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6910207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V1240OtherBLUE CROSS BLUE SHIELD
TX187150101Medicaid
TX8F3259Medicare PIN