Provider Demographics
NPI:1003076779
Name:LIVERS, GREGORY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LAWRENCE
Last Name:LIVERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 F ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2601
Mailing Address - Country:US
Mailing Address - Phone:801-364-3091
Mailing Address - Fax:
Practice Address - Street 1:129 F ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2601
Practice Address - Country:US
Practice Address - Phone:801-364-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5763903-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery