Basic Information
Provider Information
NPI: 1124217047
EntityType: 2
ReplacementNPI:  
OrganizationName: DR PATRICK G LIVINGSTON PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: 3400 W TECUMSEH RD
Address2: SUITE 106
City: NORMAN
State: OK
PostalCode: 730721810
CountryCode: US
TelephoneNumber: 4053210044
FaxNumber:  
Practice Location
Address1: 3400 W TECUMSEH RD
Address2: SUITE 106
City: NORMAN
State: OK
PostalCode: 730721810
CountryCode: US
TelephoneNumber: 4053210044
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/16/2007
LastUpdateDate: 04/09/2008
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LIVINGSTON
AuthorizedOfficialFirstName: PATRICK
AuthorizedOfficialMiddleName: GRAHAM
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 4053210044
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: D.O.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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