Provider Demographics
NPI:1326004912
Name:LIVINGSTON, JACQUELINE SUE (DO)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005C MEDICAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666
Mailing Address - Country:US
Mailing Address - Phone:512-353-0744
Mailing Address - Fax:512-353-0744
Practice Address - Street 1:2005 MEDICAL PKWY
Practice Address - Street 2:C
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7576
Practice Address - Country:US
Practice Address - Phone:512-353-0744
Practice Address - Fax:512-353-0744
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115232401Medicaid
TX82X257Medicare PIN
TXB24424Medicare UPIN