MEDICARE: DR. TRACEY LEVENS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G86419	CA

General Provider Information

NPI Number	:	1568541274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEY LEVENS M.D.

Provider Business Mailing Address
First Line	:	4817 CENTENNIAL PLAZA WAY # B
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-1957
Country	:	US
Telephone Number	:	661-213-3300
Fax Number	:	661-213-3330

Provider Business Practice Location Address
First Line	:	4817 CENTENNIAL PLAZA WAY # B
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-1957
Country	:	US
Telephone Number	:	661-213-3300
Fax Number	:	661-213-3330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	12/11/2014

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