Healthcare Provider Details

I. General information

NPI: 1760393730
Provider Name (Legal Business Name): BRUCE J LEVINE DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 JEFFORDS ST STE D
CLEARWATER FL
33756-3810
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 727-446-3338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: SERGIO ZAPICO
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 301-933-7133