Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | M4195 | ID |
N | 207VG0400X | Gynecologist | M4195 | ID |
N | 207VX0000X | Obstetrician | M4195 | ID |
NPI | 1184676454 |
---|---|
Provider Name | Peter B Livers |
First Address | Meridian, ID 83642-6351 |
Second Address | Meridian, ID 83642-6351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D93690 | (02) |