Healthcare Provider Details

I. General information

NPI: 1881687200
Provider Name (Legal Business Name): PATRICK G LIVINGSTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W TECUMSEH RD STE 106
NORMAN OK
73072-1810
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-0044
  • Fax: 405-307-5621
Mailing address:
  • Phone: 405-307-6668
  • Fax: 405-701-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3866
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: