Individual
DR. GARY R LIVERMORE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
322 WEST 50TH STREET, MINNEAPOLIS, MN 55419
(612) 821-8489
Mailing address
322 WEST 50TH STREET, MINNEAPOLIS, MN 55419
(612) 821-8489
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2236
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26860LI
BLUE CROSS
MN
Enumeration date
04/22/2006
Last updated
07/08/2007
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