Individual
BRIAN PAUL LIVERMORE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
619 5TH ST NW, BEMIDJI, MN 56601-2914
(218) 751-4144
(218) 751-3545
Mailing address
1519 LINCOLN LOG LN SW, BEMIDJI, MN 56601-9085
(218) 751-8746
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MN27911
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-29567
MN MEDICA
MN
01
—
83095LI
MN BLUECROSS BLUESHIELD
MN
01
—
HP17897
MN HEALTHPARTNERS
MN
Enumeration date
06/05/2006
Last updated
07/09/2007
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