Provider Demographics
NPI:1043477441
Name:LIU DUMLAO, THERESA ONG (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ONG
Last Name:LIU DUMLAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:LIU
Other - Last Name:DUMLAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2940 E. BANNER GATEWAY DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2165
Mailing Address - Country:US
Mailing Address - Phone:480-256-6444
Mailing Address - Fax:480-256-4003
Practice Address - Street 1:2946 E BANNER GATEWAY DR
Practice Address - Street 2:SUITE 450
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2165
Practice Address - Country:US
Practice Address - Phone:480-256-6444
Practice Address - Fax:480-256-4683
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25912207RH0000X, 207RX0202X
TXP0083207RH0003X
AZ32590207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL139243Medicaid
MS04101524Medicaid
TX287754001 (MDACC)Medicaid
TX8DC007OtherBCBS (MDACC)
AL51591744OtherBCBS - 1 INFIRMARY CIRCLE
AL139243Medicaid
ALI12176Medicare UPIN
TXTXB140756 (MDACC)Medicare PIN