Provider Demographics
NPI:1922154863
Name:LIVELY, HARRY R (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:R
Last Name:LIVELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2709
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-2709
Mailing Address - Country:US
Mailing Address - Phone:559-749-0223
Mailing Address - Fax:559-749-0886
Practice Address - Street 1:119 S LOCUST ST
Practice Address - Street 2:STE B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6251
Practice Address - Country:US
Practice Address - Phone:559-749-0223
Practice Address - Fax:559-749-0886
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56294207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G562940Medicaid
CA00G562940Medicare PIN
CA00G562940Medicaid
CAAU571ZMedicare PIN