Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1033363973 |
---|---|
Provider Name | Jeremy David Livingston |
First Address | Cody, WY 82414-4142 |
Second Address | Cody, WY 82414-4142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2008 |
Last Update Date | 03/11/2018 |