Healthcare Provider Details

I. General information

NPI: 1477513984
Provider Name (Legal Business Name): GENE R LARIVIERE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N 9TH AVE
VINTON IA
52349-2254
US

IV. Provider business mailing address

502 N 9TH AVE
VINTON IA
52349-2254
US

V. Phone/Fax

Practice location:
  • Phone: 319-472-6300
  • Fax: 319-472-6348
Mailing address:
  • Phone: 319-472-6200
  • Fax: 319-472-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-30271
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: