Individual
JEFFREY J LIUDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MAC LANE, AVERA MEDICAL GROUP PIERRE, PIERRE, SD 57501
(605) 945-5202
(605) 945-5294
Mailing address
100 MAC LANE, AVERA MEDICAL GROUP PIERRE, PIERRES, SD 57501
(605) 945-5202
(605) 945-5294
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
1242
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6520324
—
SD
05
—
6520325
—
SD
Enumeration date
08/20/2006
Last updated
09/04/2012
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