Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 036075599 | IL |
Y | 207T00000X | Neurosurgeon | ME111127 | FL |
NPI | 1063430866 |
---|---|
Provider Name | Robert Levy |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 26/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14H5V | BCBSFL (01) | FL |
D89311 | (02) |