Provider Demographics
NPI:1093747842
Name:LIVINGSTONE, KEITH SHILLING (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:SHILLING
Last Name:LIVINGSTONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 S HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2202
Mailing Address - Country:US
Mailing Address - Phone:817-346-5960
Mailing Address - Fax:817-356-5961
Practice Address - Street 1:5531 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2202
Practice Address - Country:US
Practice Address - Phone:817-346-5960
Practice Address - Fax:817-356-5961
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB100968Medicare PIN