Healthcare Provider Details

I. General information

NPI: 1669405577
Provider Name (Legal Business Name): JEFFREY C LIVINGSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 HARRISON PKWY BLDG. C - SUITE 200
SUNRISE FL
33323-2896
US

IV. Provider business mailing address

2202 STATE AVE SUITE 103
PANAMA CITY FL
32405-7601
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax: 954-598-0908
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number35-084222
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35-084222
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License Number35-084222
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number39750
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number39750
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License Number39750
License Number StateKY
# 7
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number9500394
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: