Individual
JOHN M LIVINGSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8756 W EMERALD ST, SUITE 136, BOISE, ID 83704-4831
(208) 853-3051
(208) 853-3053
Mailing address
8756 W EMERALD ST, SUITE 136, BOISE, ID 83704-4831
(208) 853-3051
(208) 853-3053
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M5148
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000192
REGENCE BLUE SHIELD OF ID
ID
Enumeration date
01/04/2007
Last updated
03/07/2023
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