Organization
LIVINGSTON PEDIATRIC CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARLO BRAWNER MD (MEDICAL DIRECTOR)
(936) 328-8812
Entity
Organization
Contact information
Practice address
400 OGLETREE DR, LIVINGSTON, TX 77351-6783
(936) 328-8812
(936) 328-8815
Mailing address
400 OGLETREE DR, LIVINGSTON, TX 77351-6783
(936) 328-8812
(936) 328-8815
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
J6500
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0045LZ
BCBS GROUP NUMBER
TX
05
—
169920905
—
TX
05
—
169920906
—
TX
05
—
169920907
—
TX
05
—
169920908
—
TX
05
—
169920909
—
TX
05
—
169920910
—
TX
Enumeration date
01/19/2007
Last updated
06/19/2024
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