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NPI Code Detail

MEDICARE: DR. RICHARD MARK SHIVERS MD

MEDICARE:  DR. RICHARD MARK SHIVERS  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35-065781OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01712254OTHEROHRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639268352
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD MARK SHIVERS MD
Provider Business Mailing Address
First Line : 9471 MARKET ST
Second Line : STE B
City : NORTH LIMA
State : OH
Zip : 44452-8702
Country : US
Telephone Number : 330-729-2388
Fax Number : 330-629-6468
Provider Business Practice Location Address
First Line : 564 E 2ND ST
Second Line :
City : SALEM
State : OH
Zip : 44460-2914
Country : US
Telephone Number : 234-567-8150
Fax Number : 234-567-8189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 08/15/2018

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Directions to “ DR. RICHARD MARK SHIVERS MD” Practice Location

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