Provider Demographics
NPI:1649679903
Name:LIVINGSTON, B. A. DOC
Entity type:Individual
Prefix:
First Name:B. A. DOC
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-0031
Mailing Address - Country:US
Mailing Address - Phone:530-218-5479
Mailing Address - Fax:530-741-9269
Practice Address - Street 1:7434 DOC ADAMS RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-3114
Practice Address - Country:US
Practice Address - Phone:530-218-5479
Practice Address - Fax:530-741-9269
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist