Provider Demographics
NPI:1487870655
Name:LIVINGSTON, RONALD (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W REYNOSA ST
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444
Mailing Address - Country:US
Mailing Address - Phone:254-893-5895
Mailing Address - Fax:254-893-5222
Practice Address - Street 1:1100 W REYNOSA ST
Practice Address - Street 2:
Practice Address - City:DE LEON
Practice Address - State:TX
Practice Address - Zip Code:76444
Practice Address - Country:US
Practice Address - Phone:254-893-5895
Practice Address - Fax:254-893-5222
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H4300OtherBCBS
TXD97495Medicare UPIN
TX8H4300OtherBCBS