Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 15189 | NV |
NPI | 1003042847 |
---|---|
Provider Name | Mark Livingston |
First Address | Las Vegas, NV 89148-1253 |
Second Address | Las Vegas, NV 89148-1253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2009 |
Last Update Date | 08/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003042847 | (05) | NV |