Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 56907 | CA |
NPI | 1083728141 |
---|---|
Provider Name | Dr. Philip Montgomery Livingood |
First Address | Los Alamitos, CA 90720-2003 |
Second Address | Los Alamitos, CA 90720-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 04/03/2014 |