Provider Demographics
NPI:1609949601
Name:LIVINGSTON, ROBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000160312085N0700X
WAMD00D160312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA300020214OtherRR MEDICARE TRA
WALI2582OtherREGENCE BLUE SHIELD TRA
WALI7252OtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WA119258OtherLABOR AND INDUSTRIES/WC UNION AVENUE OPEN
WA40719OtherLABOR AND INDUSTRIES/WC TRA
WAAB36539OtherMEDICARE PIN TRA KING COUNTY
WA8388506Medicaid
WA119258OtherLABOR AND INDUSTRIES/WC UNION AVENUE OPEN
WAAB36539OtherMEDICARE PIN TRA KING COUNTY
WAA08965Medicare UPIN