Provider Demographics
NPI:1053545871
Name:LIVINGSTON, RILEY BAKER (MD, MPH)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:BAKER
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:BAKER
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:4916 PROVENCE CIR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2286
Mailing Address - Country:US
Mailing Address - Phone:205-585-4421
Mailing Address - Fax:833-377-4539
Practice Address - Street 1:4916 PROVENCE CIR
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35242-2286
Practice Address - Country:US
Practice Address - Phone:205-585-4421
Practice Address - Fax:833-377-4539
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30591208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL217430Medicaid
AL512-08979OtherBLUE CROSS BLUE SHIELD OF ALABAMA