Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 5763903-1205 | UT |
Y | 208600000X | Surgeon | 5763903-1205 | UT |
NPI | 1003076779 |
---|---|
Provider Name | Dr. Gregory Lawrence Livers |
First Address | Salt Lake City, UT 84103-2601 |
Second Address | Salt Lake City, UT 84103-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 16/06/2008 |