Provider Demographics
NPI:1023236957
Name:LIVINGSTON FAMILY MEDICINE, P.A.
Entity type:Organization
Organization Name:LIVINGSTON FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:VINICE BOLTON
Authorized Official - Last Name:BRUNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-327-3843
Mailing Address - Street 1:300 BYPASS LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8413
Mailing Address - Country:US
Mailing Address - Phone:936-327-3843
Mailing Address - Fax:936-327-7132
Practice Address - Street 1:300 BYPASS LN
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8413
Practice Address - Country:US
Practice Address - Phone:936-327-3843
Practice Address - Fax:936-327-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG85822Medicare UPIN