Provider Demographics
NPI:1578596466
Name:LIVERNOIS, RICHARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:LIVERNOIS
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 1:5101 N DAVIS HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2034
Mailing Address - Country:US
Mailing Address - Phone:850-438-1277
Mailing Address - Fax:850-438-1278
Practice Address - Street 1:5101 N DAVIS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2034
Practice Address - Country:US
Practice Address - Phone:850-438-1277
Practice Address - Fax:850-438-1278
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76798207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA454661776AMedicaid
GA454661776AMedicaid
GA1078920007Medicare NSC
FL44527UMedicare PIN
GA511I180097Medicare Oscar/Certification