Provider Demographics
NPI:1427156108
Name:LIVERMAN, STEVEN BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BARRY
Last Name:LIVERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:WESSON
Mailing Address - State:MS
Mailing Address - Zip Code:39191-0157
Mailing Address - Country:US
Mailing Address - Phone:601-643-5878
Mailing Address - Fax:601-643-2561
Practice Address - Street 1:1096 BEECH ST
Practice Address - Street 2:
Practice Address - City:WESSON
Practice Address - State:MS
Practice Address - Zip Code:39191
Practice Address - Country:US
Practice Address - Phone:601-643-5878
Practice Address - Fax:601-643-2561
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08375207Q00000X
NC25930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB30726Medicare UPIN
MS00011023Medicare ID - Type Unspecified
MS080000170Medicare ID - Type Unspecified