Individual provider Active NPI

William George Liakos Jr., M.D.

  • Pediatrics Physician
  • Roswell, NM
National Provider Identifier
1184676249
Registry record updated Jun 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
99-75 Issued in NM
Practice address
813 N Washington Ave
Roswell, NM 88201-3941
Phone
(575) 622-2606
Fax
(575) 622-6645
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 99-75 NM Primary

Addresses

Primary practice location

813 N Washington Ave
Roswell, NM 88201-3941

Mailing address

813 N Washington Ave
Roswell, NM 88201-3941
Phone (575) 622-2606

Other identifiers 1

IdentifierTypeStateIssuer
Z4477MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120423000588 NM Practitioner - Pediatric Medicine 3779543855

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: liakos@bca.pcc-direct.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307318400000",
    "number": "1184676249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 N WASHINGTON AVE",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882013941",
            "telephone_number": "575-622-2606",
            "fax_number": "575-622-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 N WASHINGTON AVE",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882013941",
            "telephone_number": "575-622-2606",
            "fax_number": "575-622-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIAKOS",
        "first_name": "WILLIAM",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2011-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "99-75",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z4477",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

Verify at the official NPI Registry.