Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 48 | MT |
NPI | 1235171851 |
---|---|
Provider Name | Mr. Douglas P Livingstone |
First Address | Great Falls, MT 59405-4324 |
Second Address | Great Falls, MT 59405-4324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000066070 | BLUE CROSS BLUE SHIELD (01) | MT |
0141385 | WASHINGTON L & I (01) | MT |
3400787 | (05) | MT |
810347861 | CHAMPUS (01) | MT |
810347861006 | EBMS (01) | MT |
P00134072 | RAILROAD MEDICARE (01) | MT |