Provider Demographics
NPI:1871592949
Name:LIVINGSTON, DOUGLAS R (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:LIVINGSTON
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1035 N EMPORIA ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2944
Mailing Address - Country:US
Mailing Address - Phone:316-262-7500
Mailing Address - Fax:316-262-1969
Practice Address - Street 1:1035 N EMPORIA ST
Practice Address - Street 2:SUITE 208
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2944
Practice Address - Country:US
Practice Address - Phone:316-262-7500
Practice Address - Fax:316-262-1969
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
KS17974207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB69118Medicare UPIN