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General NPI Number Information
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NPI Number | 1639287451
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Entity Type | Organization
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Legal Business Name | KEITH S. LIVINGSTONE M D P A
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 6601 DAN DANCIGER RD SUITE 200
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City | FORT WORTH
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State | TX
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Zip | 76133
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Country | US
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Telephone | 817-294-5600
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Fax | 817-263-7234
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Provider Business Mailing Address
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Address Line | 6601 DAN DANCIGER RD SUITE 200
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City | FORT WORTH
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State | TX
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Zip | 76133
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Country | US
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Telephone | 817-294-5600
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Fax | 817-263-7234
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Authorized Official
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Title or Position | OWNER
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Name | KEITH SHILLING LIVINGSTONE
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Credential | MD
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Telephone | 817-294-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G5305
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License Number State | TX
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