Healthcare Provider Details

I. General information

NPI: 1548491079
Provider Name (Legal Business Name): LIVINGSTON PARSONS, JR. JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 ASPEN, N.E.
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

4208 ASPEN, N.E.
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-9146
  • Fax: 505-268-9146
Mailing address:
  • Phone: 505-268-9146
  • Fax: 505-268-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number58-54
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: