MEDICARE: LEON LIVINGSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35123	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	6012717	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1972507796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEON LIVINGSTON MD

Provider Business Mailing Address
First Line	:	1211 UNION AVE STE 330
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 N DUNLAP ST FL 3
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38105-4625
Country	:	US
Telephone Number	:	901-523-2945
Fax Number	:	901-523-8488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	12/13/2024

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Directions to “ LEON LIVINGSTON MD” Practice Location

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