Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G8241 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | G8241 | TX |
NPI | 1295741304 |
---|---|
Provider Name | Eric Levy |
First Address | Amarillo, TX 79106-1708 |
Second Address | Amarillo, TX 79106-1786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 27/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100152890A | (05) | OK |
136970410 | (05) | TX |
136970411 | (05) | TX |
136970412 | (05) | TX |
136970413 | (05) | TX |
8E0575 | MEDICARE (01) | TX |
C18384 | (02) | |
X4469 | (05) | NM |