Provider Demographics
NPI:1497846679
Name:LIVERMORE, JAMES L (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:LIVERMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1789 ELM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-2256
Mailing Address - Country:US
Mailing Address - Phone:563-690-2860
Mailing Address - Fax:563-582-5335
Practice Address - Street 1:1789 ELM ST
Practice Address - Street 2:SUITE A
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-2256
Practice Address - Country:US
Practice Address - Phone:563-690-2860
Practice Address - Fax:563-582-5335
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA38859208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200522050Medicaid