Basic Information
| Provider Information | |||||||||
| NPI: | 1306801808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIVINGSTONE | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 NW 14TH ST STE 450B | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331362107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052434902 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1120 NW 14TH ST STE 450B | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331362107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052434902 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | ME26728 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0397377-00 | 05 | FL | MEDICAID |