Healthcare Provider Details

I. General information

NPI: 1497846679
Provider Name (Legal Business Name): JAMES L. LIVERMORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 ELM ST SUITE A
DUBUQUE IA
52001-2256
US

IV. Provider business mailing address

1789 ELM ST SUITE A
DUBUQUE IA
52001-2256
US

V. Phone/Fax

Practice location:
  • Phone: 563-690-2860
  • Fax: 563-582-5335
Mailing address:
  • Phone: 563-690-2860
  • Fax: 563-582-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38859
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: