Provider Demographics
NPI:1235302274
Name:LIVE DRY LLC
Entity Type:Organization
Organization Name:LIVE DRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-896-0860
Mailing Address - Street 1:3501 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3636
Mailing Address - Country:US
Mailing Address - Phone:972-257-5300
Mailing Address - Fax:972-257-5321
Practice Address - Street 1:3501 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3636
Practice Address - Country:US
Practice Address - Phone:972-257-5300
Practice Address - Fax:972-257-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0320207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty