Provider Demographics
NPI:1477528750
Name:LIVINGSTON, WILLIAM C (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:C
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8901 INDIAN HILLS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4057
Mailing Address - Country:US
Mailing Address - Phone:402-397-7057
Mailing Address - Fax:402-397-6656
Practice Address - Street 1:8901 INDIAN HILLS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4057
Practice Address - Country:US
Practice Address - Phone:402-397-7057
Practice Address - Fax:402-397-6656
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2678207RG0100X
NE127207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025290600Medicaid
NE47077295213Medicaid
NEF05654Medicare UPIN
NE10025290600Medicaid
NE47077295213Medicaid