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General NPI Number Information
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NPI Number | 1750652384
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Entity Type | Organization
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Legal Business Name | JOHN M LIVINGSTON MD PA
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 8756 W EMERALD ST SUITE 136
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City | BOISE
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State | ID
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Zip | 83704-4831
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Country | US
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Telephone | 208-853-3051
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Fax | 208-853-3053
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Provider Business Mailing Address
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Address Line | 8756 W EMERALD ST SUITE 136
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City | BOISE
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State | ID
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Zip | 83704-4831
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Country | US
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Telephone | 208-853-3051
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Fax | 208-853-3053
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN M LIVINGSTON
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Credential | MD
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Telephone | 208-853-3051
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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 |
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License Number State |
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