Provider Demographics
NPI:1235119900
Name:LIVSTONE, ELLIOT MARSH (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:MARSH
Last Name:LIVSTONE
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SOUTH OSPREY AVE
Mailing Address - Street 2:SUITE C 11
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2912
Mailing Address - Country:US
Mailing Address - Phone:941-955-0000
Mailing Address - Fax:941-955-1686
Practice Address - Street 1:1515 SOUTH OSPREY AVE
Practice Address - Street 2:SUITE C 11
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2912
Practice Address - Country:US
Practice Address - Phone:941-955-0000
Practice Address - Fax:941-955-1686
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042953207RG0100X
CT15207207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58421Medicare PIN