Basic Information
| Provider Information | |||||||||
| NPI: | 1609949601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIVINGSTON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1535 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984011535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2533833553 | ||||||||
| Practice Location | |||||||||
| Address1: | 1304 FAWCETT AVENUE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984021911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2533833553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 01/26/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 00016031 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | MD00D16031 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300020214 | 01 | WA | RR MEDICARE TRA | OTHER | LI2582 | 01 | WA | REGENCE BLUE SHIELD TRA | OTHER | LI7252 | 01 | WA | REGENCE BLUE SHIELD UNION AVENUE OPEN | OTHER | 119258 | 01 | WA | LABOR AND INDUSTRIES/WC UNION AVENUE OPEN | OTHER | 40719 | 01 | WA | LABOR AND INDUSTRIES/WC TRA | OTHER | AB36539 | 01 | WA | MEDICARE PIN TRA KING COUNTY | OTHER | 8388506 | 05 | WA | MEDICAID |