Provider Demographics
NPI:1669453205
Name:LIVINGSTON, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:PATRICK
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 21725
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-1725
Mailing Address - Country:US
Mailing Address - Phone:405-751-2828
Mailing Address - Fax:405-751-1253
Practice Address - Street 1:4205 MCAULEY BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9391
Practice Address - Country:US
Practice Address - Phone:405-751-2828
Practice Address - Fax:405-751-1253
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10712207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1001344608Medicaid
OK1001344608Medicaid