Basic Information
| Provider Information | |||||||||
| NPI: | 1336268010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIVINGSTON | ||||||||
| FirstName: | BOBBIE | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3025 S PARKER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034817030 | ||||||||
| FaxNumber: | 3037457665 | ||||||||
| Practice Location | |||||||||
| Address1: | 3025 S PARKER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034817030 | ||||||||
| FaxNumber: | 3037457665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 08/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 24828 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 24828 | 01 | CO | LICENSE | OTHER | 01248285 | 05 | CO | MEDICAID |