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General NPI Number Information
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NPI Number | 1700114501
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Entity Type | Organization
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Legal Business Name | ELLIOT M. LIVSTONE, MD, PA
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 1515 S OSPREY AVE SUITE C11
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City | SARASOTA
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State | FL
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Zip | 34239-2939
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Country | US
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Telephone | 941-955-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 S OSPREY AVE SUITE C11
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City | SARASOTA
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State | FL
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Zip | 34239-2939
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Country | US
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Telephone | 941-955-0000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ELLIOT M LIVSTONE
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Credential | MD
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Telephone | 941-955-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0042953
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License Number State | FL
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