Provider Demographics
NPI:1245220839
Name:LIVINGSTON, JOSHUA J (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:J
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8304
Mailing Address - Country:US
Mailing Address - Phone:918-743-3636
Mailing Address - Fax:918-743-3663
Practice Address - Street 1:2033 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8304
Practice Address - Country:US
Practice Address - Phone:918-743-3636
Practice Address - Fax:918-743-3663
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4209208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200031520AMedicaid
OK247700503Medicare PIN
OK200031520AMedicaid
I07010Medicare UPIN