MEDICARE: E FRANKLIN LIVINGSTONE MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	31013	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	Z74943	OTHER	AZ	MEDICARE PROV #
4	250014204	OTHER	AZ	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212162	OTHER	AZ	DEPARTMENT OF LABOR
2	A14947	OTHER	AZ	UPIN
5	AZ0733210	OTHER	AZ	BC/BS OF AZ

General Provider Information

NPI Number	:	1124202726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E FRANKLIN LIVINGSTONE MD PC

Provider Business Mailing Address
First Line	:	3560 ORO GRANDE BLVD # 1000
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-7209
Country	:	US
Telephone Number	:	928-854-0011
Fax Number	:	928-854-0012

Provider Business Practice Location Address
First Line	:	297 LAKE HAVASU AVE S
Second Line	:	STE 106
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6526
Country	:	US
Telephone Number	:	928-854-0011
Fax Number	:	928-854-0012

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	E FRANKLIN LIVINGSTONE MD PC
Credential	:	MD
Telephone Number	:	928-854-0011

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	03/04/2013

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Directions to “E FRANKLIN LIVINGSTONE MD PC ” Practice Location

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