Provider Demographics
NPI:1669434270
Name:LIVECCHI, JOHN T (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:LIVECCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 100284
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0284
Mailing Address - Country:US
Mailing Address - Phone:352-273-8778
Mailing Address - Fax:352-273-7402
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-4944
Practice Address - Country:US
Practice Address - Phone:352-273-8778
Practice Address - Fax:352-273-7402
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME86805207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025052600Medicaid
FL266163200Medicaid
FLB41831Medicare UPIN
FL57615VMedicare PIN
FL57615WMedicare PIN
FL266163200Medicaid
FL57615ZMedicare ID - Type Unspecified