Provider Demographics
NPI:1245295419
Name:LIVINGSTON, STEPHEN H (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
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 1:525 OKEECHOBEE BLVD FL 14
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6349
Mailing Address - Country:US
Mailing Address - Phone:561-804-0200
Mailing Address - Fax:561-804-0222
Practice Address - Street 1:525 OKEECHOBEE BLVD FL 14
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6349
Practice Address - Country:US
Practice Address - Phone:561-804-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56909207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372083700Medicaid
FL372083700Medicaid
FL17740ZMedicare ID - Type Unspecified