Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PO1701 | FL |
Y | 213ES0000X | Sports Medicine | PO1701 | FL |
NPI | 1275560880 |
---|---|
Provider Name | Dr. Robert Levine |
First Address | Seminole, FL 33777-4307 |
Second Address | Seminole, FL 33777-4307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 06/08/2008 |