Active NPI
Jeffrey Liddell, M.D.
- Adult Medicine Physician
- Dallas, TX
National Provider Identifier
1376583955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Medicine Physician
- License
- J7809
- Practice address
- 4131 N Central Expy
Suite 440 - Fitzhugh-Central Professional Tower
Dallas, TX 75204-2102 - Phone
- (214) 521-3091
- Fax
- (214) 521-2182
- NPI assigned
- Jun 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | J7809 | TX | Primary |
Addresses
Primary practice location
4131 N Central Expy
Suite 440 - Fitzhugh-Central Professional Tower
Dallas, TX 75204-2102
Mailing address
4131 N Central Expy
Suite 440 - Fitzhugh-Central Professional Tower
Dallas, TX 75204-2102
Phone (214) 521-3091
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122110304 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J7809 | TX | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290470400000",
"number": "1376583955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4131 N CENTRAL EXPY",
"address_2": "SUITE 440 - FITZHUGH-CENTRAL PROFESSIONAL TOWER",
"city": "DALLAS",
"state": "TX",
"postal_code": "752042102",
"telephone_number": "214-521-3091",
"fax_number": "214-521-2182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4131 N CENTRAL EXPY",
"address_2": "SUITE 440 - FITZHUGH-CENTRAL PROFESSIONAL TOWER",
"city": "DALLAS",
"state": "TX",
"postal_code": "752042102",
"telephone_number": "214-521-3091",
"fax_number": "214-521-2182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDDELL",
"first_name": "JEFFREY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-08",
"last_updated": "2010-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "TX",
"license": "J7809",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "122110304",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.