Provider Demographics
NPI:1073545760
Name:LIVINGSTON, CHARLES DUNCAN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DUNCAN
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3901 MEDICAL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4027
Mailing Address - Country:US
Mailing Address - Phone:512-467-7151
Mailing Address - Fax:512-467-8809
Practice Address - Street 1:3901 MEDICAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4027
Practice Address - Country:US
Practice Address - Phone:512-467-7151
Practice Address - Fax:512-467-8809
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6479208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0043AKOtherMEDICARE P-TIN
TX114750601Medicaid
TX0043AKOtherMEDICARE P-TIN
TX0043AKOtherMEDICARE P-TIN