Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN0012344 | FL |
NPI | 1053524462 |
---|---|
Provider Name | Mark Levinsky |
First Address | St Petersburg, FL 33703-6305 |
Second Address | St Petersburg, FL 33703-2612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 21/01/2008 |