Individual
DR. CHARLES AUBORN LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
608 N MUSKINGUM AVE, ODESSA, TX 79761-4539
(432) 580-9168
(432) 580-8221
Mailing address
608 N MUSKINGUM AVE, ODESSA, TX 79761-4539
(432) 580-9168
(432) 335-9217
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
H6384
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123169804
—
TX
Enumeration date
07/27/2006
Last updated
12/15/2020
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