Organization
CHARLES A LIVELY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES A LIVELY M.D. (OWNER PHYSICIAN)
(432) 580-9168
Entity
Organization
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) 580-8221
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
H6384
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123169807
—
TX
01
—
50072573
DPS
TX
01
—
H6384
H6384
TX
Enumeration date
05/10/2007
Last updated
03/07/2023
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