Provider Demographics
NPI:1447315130
Name:LIVINGSTONE MD PC, E. FRANKLIN (MD)
Entity type:Individual
Prefix:
First Name:E.
Middle Name:FRANKLIN
Last Name:LIVINGSTONE MD PC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3560 ORO GRANDE BLVD # 1000
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-7209
Mailing Address - Country:US
Mailing Address - Phone:928-854-0011
Mailing Address - Fax:928-854-0012
Practice Address - Street 1:1519 QUEENS BAY STE 201
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6585
Practice Address - Country:US
Practice Address - Phone:928-854-0011
Practice Address - Fax:928-854-0012
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31013208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ744145Medicaid
AZAZ0733210OtherBC/BS OF AZ
AZ250014204OtherMEDICARE RAILROAD
AZZ74943OtherMEDICARE
AZ212162OtherDEPT OF LABOR
AZAZ0733210OtherBC/BS OF AZ