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General NPI Number Information
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NPI Number | 1649679903
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Entity Type | Individual
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Provider Name | B. A. DOC LIVINGSTON
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Gender | Male
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 7434 DOC ADAMS RD
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City | MARYSVILLE
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State | CA
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Zip | 95901-3114
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Country | US
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Telephone | 530-218-5479
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Fax | 530-741-9269
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Provider Business Mailing Address
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Address Line | PO BOX 1123
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City | MARYSVILLE
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State | CA
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Zip | 95901-0031
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Country | US
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Telephone | 530-218-5479
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Fax | 530-741-9269
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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