Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | R1F75 | MO |
N | 208D00000X | General Practice Physician | R1F75 | MO |
NPI | 1013981109 |
---|---|
Provider Name | Dr. Steven B Livingstone |
First Address | Saint Louis, MO 63195-5534 |
Second Address | Saint Charles, MO 63303-2106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A66392 | (02) | MO |
P00082066 | RAILROAD MEDICARE (01) | MO |