MEDICARE: RONALD EDWIN LIVERMONT 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
1	207Q00000X	Family Medicine Physician	2013	AK

Other Identifiers

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

General Provider Information

NPI Number	:	1770553372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD EDWIN LIVERMONT MD

Provider Business Mailing Address
First Line	:	1000 HEALTH CENTER ROAD
Second Line	:
City	:	KYLE
State	:	SD
Zip	:	57752-0000
Country	:	US
Telephone Number	:	605-455-8214
Fax Number	:	605-455-1529

Provider Business Practice Location Address
First Line	:	1000 HEALTH CENTER ROAD
Second Line	:
City	:	KYLE
State	:	SD
Zip	:	57752-0000
Country	:	US
Telephone Number	:	605-455-8214
Fax Number	:	605-455-1529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	06/07/2013

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