Provider Demographics
NPI:1801966718
Name:LIVELY, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LIVELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2500 ALHAMBRA AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-3156
Mailing Address - Country:US
Mailing Address - Phone:925-628-2439
Mailing Address - Fax:925-634-2856
Practice Address - Street 1:2500 ALHAMBRA AVENUE
Practice Address - Street 2:CONTRA COSTA REGIONAL MEDICAL CENTER AND HEALTH CENTERS
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3156
Practice Address - Country:US
Practice Address - Phone:925-370-5110
Practice Address - Fax:925-370-5142
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG51791207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A52079Medicare UPIN