Provider Demographics
NPI:1336268010
Name:LIVINGSTON, BOBBIE JO (MD)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JO
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 S PARKER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2914
Mailing Address - Country:US
Mailing Address - Phone:303-481-7030
Mailing Address - Fax:303-745-7665
Practice Address - Street 1:3025 S PARKER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2914
Practice Address - Country:US
Practice Address - Phone:303-481-7030
Practice Address - Fax:303-745-7665
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24828207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24828OtherLICENSE
CO01248285Medicaid
COCOA106765Medicare PIN
CO24828OtherLICENSE
COCO40577Medicare PIN