Provider Demographics
NPI:1891938460
Name:GREGORY L LIVERS, MD, PC
Entity Type:Organization
Organization Name:GREGORY L LIVERS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:LIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-478-0010
Mailing Address - Street 1:24 S 1100 E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1500
Mailing Address - Country:US
Mailing Address - Phone:801-478-0010
Mailing Address - Fax:801-363-1847
Practice Address - Street 1:24 S 1100 E
Practice Address - Street 2:SUITE 201
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1500
Practice Address - Country:US
Practice Address - Phone:801-478-0010
Practice Address - Fax:801-363-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5763903-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty