1922390251 NPI number — MR. KEVIN DAVID LIVINGSTON D.O.

Table of content: MR. KEVIN DAVID LIVINGSTON D.O. (NPI 1922390251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922390251 NPI number — MR. KEVIN DAVID LIVINGSTON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIVINGSTON
Provider First Name:
KEVIN
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922390251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 ESCALANTE DRIVE
Provider Second Line Business Mailing Address:
#205
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-259-1971
Provider Business Mailing Address Fax Number:
970-259-4036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 ESCALANTE DRIVE
Provider Second Line Business Practice Location Address:
#205
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-259-1971
Provider Business Practice Location Address Fax Number:
970-259-4036
Provider Enumeration Date:
05/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  54230 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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