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General NPI Number Information
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NPI Number | 1588004865
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Entity Type | Individual
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Provider Name | ROBERT JOSEPH LIDDIARD DPM
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Gender | Male
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 12523 S CREEK MEADOW RD STE 105
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City | RIVERTON
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State | UT
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Zip | 84065-7299
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Country | US
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Telephone | 801-253-6886
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Fax |
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Provider Business Mailing Address
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Address Line | 12523 S CREEK MEADOW RD STE 105
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City | RIVERTON
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State | UT
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Zip | 84065-7299
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Country | US
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Telephone | 801-253-6886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5608
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | T51-2013
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 13327657-0501
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 80224
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License Number State | MS
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