Individual
JOHN RUSSELL LIVENGOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
780 SW 24TH ST, MEDICAL ADMINISTRATION, FORT LAUDERDALE, FL 33315-2643
(954) 467-4822
Mailing address
780 SW 24TH ST, MEDICAL ADMINISTRATION, FORT LAUDERDALE, FL 33315-2643
(954) 467-4822
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME91299
FL
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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