Healthcare Provider Details

I. General information

NPI: 1598176695
Provider Name (Legal Business Name): LIVINGSTON NUAMAH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 US HIGHWAY 98 W SUITE 102
SANTA ROSA BEACH FL
32459-5385
US

IV. Provider business mailing address

2441 US HIGHWAY 98 W SUITE 102
SANTA ROSA BEACH FL
32459-5385
US

V. Phone/Fax

Practice location:
  • Phone: 850-267-4554
  • Fax:
Mailing address:
  • Phone: 850-267-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO2577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: