Individual
DR. JOSEPH CHARLES LIVENGOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1650 COWLES ST, FAIRBANKS, AK 99701-5907
(907) 458-5358
Mailing address
759 HAIDA LN, FAIRBANKS, AK 99712-2925
(907) 370-2533
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
37815
CO
208600000X
Surgery Physician
MD60832644
WA
208600000X
Surgery Physician
Primary
MEDS7502
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116218700
—
WY
05
—
1440711-01
—
TX
05
—
1584760
—
AK
05
—
69307563
—
CO
05
—
84151469200
—
NE
01
—
P00944662
MEDICARE RAILROAD CARRIER PTAN
CO
Enumeration date
11/08/2005
Last updated
12/03/2025
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