Provider Demographics
NPI:1598718553
Name:LIVINGSTON, PETER GRAVES (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GRAVES
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5117 26TH ST W
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-2203
Mailing Address - Country:US
Mailing Address - Phone:941-567-4078
Mailing Address - Fax:941-896-7878
Practice Address - Street 1:5117 26TH ST W
Practice Address - Street 2:SUITE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2203
Practice Address - Country:US
Practice Address - Phone:941-567-4078
Practice Address - Fax:941-896-7878
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA13218R207W00000X
FLME102736207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAN586ZMedicare Oscar/Certification
FLG96651Medicare UPIN
FLG96651Medicare UPIN
LA1556980Medicaid
LA5E649Medicare ID - Type Unspecified
FLAN586ZMedicare Oscar/Certification