=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124217047
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR PATRICK G LIVINGSTON PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2007
-----------------------------------------------------
Last Update Date | 04/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 W TECUMSEH RD SUITE 106
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73072-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-321-0044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 W TECUMSEH RD SUITE 106
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73072-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-321-0044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICK GRAHAM LIVINGSTON
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 405-321-0044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------