Provider Demographics
NPI:1942214556
Name:LIEVING, LOREE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREE
Middle Name:J
Last Name:LIEVING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:731 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6377
Mailing Address - Country:US
Mailing Address - Phone:817-912-8800
Mailing Address - Fax:817-912-8810
Practice Address - Street 1:731 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6377
Practice Address - Country:US
Practice Address - Phone:817-912-8800
Practice Address - Fax:817-912-8810
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89075GOtherBCBS
TX100720501Medicaid
TX80367KMedicare PIN
TXG14968Medicare UPIN
TX110186372Medicare PIN
TX110186372OtherRR MEDICARE