=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538783154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LIVINGSTON PFALZGRAF MARTIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2020
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 MADISON AVE N STE 200
-----------------------------------------------------
City | BAINBRIDGE ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98110-1890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-528-8000
-----------------------------------------------------
Fax | 206-880-7890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 ASHBURY CT NW
-----------------------------------------------------
City | BAINBRIDGE ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98110-5160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-678-0344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083C0008X
-----------------------------------------------------
Taxonomy Name | Clinical Informatics Physician
-----------------------------------------------------
License Number | MD61321643
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD61321643
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------