Provider Demographics
NPI:1992512214
Name:LIVINGSTON, ALIDA MILLER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:ALIDA
Middle Name:MILLER
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-0129
Mailing Address - Country:US
Mailing Address - Phone:205-259-9228
Mailing Address - Fax:
Practice Address - Street 1:4110 BRIARGATE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7837
Practice Address - Country:US
Practice Address - Phone:719-632-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008607207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine