Healthcare Provider Details

I. General information

NPI: 1144409137
Provider Name (Legal Business Name): JONATHAN JAY LEVIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 N ALLIED WAY SUITE 100
PHOENIX AZ
85054-3105
US

IV. Provider business mailing address

18325 N ALLIED WAY SUITE 100
PHOENIX AZ
85054-3105
US

V. Phone/Fax

Practice location:
  • Phone: 602-467-4966
  • Fax: 480-419-5401
Mailing address:
  • Phone: 602-467-4966
  • Fax: 480-419-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number51173
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: