Individual
MICHAEL SHAWN LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
710 WATER ST, KERRVILLE, TX 78028-5329
(830) 258-7747
Mailing address
1845 FOOTHILLS DR, KERRVILLE, TX 78028-3873
(717) 246-9097
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M3632
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180018701
—
TX
01
—
180018702
CSHCN
TX
01
—
8M6794
BCBS
TX
Enumeration date
05/03/2006
Last updated
05/12/2009
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