Provider Demographics
NPI:1588004865
Name:LIDDIARD, ROBERT JOSEPH (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:LIDDIARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12523 S CREEK MEADOW RD STE 105
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7299
Mailing Address - Country:US
Mailing Address - Phone:801-253-6886
Mailing Address - Fax:
Practice Address - Street 1:12523 S CREEK MEADOW RD STE 105
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7299
Practice Address - Country:US
Practice Address - Phone:801-253-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA5608213ES0103X
TXT51-2013213ES0103X
UT13327657-0501213ES0103X
MS80224213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery