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NPI Code Detail

MEDICARE: LIVEUPMEDICAL PLLC

MEDICARE: LIVEUPMEDICAL PLLC
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 Physician

General Provider Information

NPI Number : 1063911683
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVEUPMEDICAL PLLC
Provider Business Mailing Address
First Line : 3000 S HULEN ST STE 124-558
Second Line :
City : FT WORTH
State : TX
Zip : 76109-1929
Country : US
Telephone Number : 940-484-0914
Fax Number :
Provider Business Practice Location Address
First Line : 205 N BONNIE BRAE ST
Second Line :
City : DENTON
State : TX
Zip : 76201-3766
Country : US
Telephone Number : 940-384-1500
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SHANE F STONE
Credential : MD
Telephone Number : 864-285-7227
Provider Enumeration Date : 02/09/2018
Last Update Date : 04/26/2018

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Directions to “LIVEUPMEDICAL PLLC ” Practice Location

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