Individual
DR. RYAN LIVENGOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
327 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9006
(681) 342-1523
(681) 342-1548
Mailing address
327 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9006
(681) 342-1523
(681) 342-1548
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
22497
WV
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
22497
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3810014842
MEDICAID
WV
01
—
WV3496A
MEDICARE PTAN
WV
Enumeration date
06/27/2007
Last updated
04/07/2022
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