Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | F4210 | TX |
Y | 207NP0225X | Pediatric Dermatologist | F4210 | TX |
NPI | 1013097419 |
---|---|
Provider Name | Moise Levy |
First Address | Austin, TX 78723-3078 |
Second Address | Austin, TX 78723-3078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 10/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134853409 | (05) | TX |
C18385 | (02) |