Provider Demographics
NPI:1851465520
Name:LIVINGSTON, ROBERT T (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21 NEEDLES LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2606
Mailing Address - Country:US
Mailing Address - Phone:386-254-2285
Mailing Address - Fax:386-425-1304
Practice Address - Street 1:60 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5980
Practice Address - Country:US
Practice Address - Phone:386-586-2010
Practice Address - Fax:386-425-1304
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0083159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262597100Medicaid
FLME83159OtherSTATE MEDICAL LICENSE
FLME83159OtherSTATE MEDICAL LICENSE
FL06062ZMedicare PIN