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General NPI Number Information
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NPI Number | 1265164198
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Entity Type | Individual
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Provider Name | VIRGIL GENE LIVINGSTON MD-DPM
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Gender | Male
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 12411 NE 70TH CIR
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City | VANCOUVER
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State | WA
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Zip | 98682-4885
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Country | US
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Telephone | 602-615-9915
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Fax |
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Provider Business Mailing Address
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Address Line | 12411 NE 70TH CIR STE 106
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City | VANCOUVER
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State | WA
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Zip | 98682-4885
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Country | US
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Telephone | 602-615-9915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO00000166
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO00000166
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License Number State | WA
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