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General NPI Number Information
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NPI Number | 1518948447
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Entity Type | Individual
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Provider Name | JOSEPH CHARLES LIVENGOOD M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1650 COWLES ST
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City | FAIRBANKS
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State | AK
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Zip | 99701-5907
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Country | US
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Telephone | 907-458-5358
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Fax |
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Provider Business Mailing Address
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Address Line | 759 HAIDA LN
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City | FAIRBANKS
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State | AK
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Zip | 99712-2925
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Country | US
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Telephone | 907-370-2533
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MEDS7502
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD60832644
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 37815
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License Number State | CO
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