Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME51828 | FL |
NPI | 1114914249 |
---|---|
Provider Name | Dr. David Alan Levine |
First Address | St Petersburg, FL 33710-2174 |
Second Address | St Petersburg, FL 33710-2174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 04/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038968400 | (05) | FL |
07794 | BCBS (01) | FL |
E22424 | (02) |