Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 10789 | FL |
NPI | 1043318744 |
---|---|
Provider Name | Mitchell Robert Levine |
First Address | Jacksonville, FL 32257 |
Second Address | Jacksonville, FL 32257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |