Healthcare Provider Details

I. General information

NPI: 1396756474
Provider Name (Legal Business Name): ROBERT W. LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 MASON AVE SUITE# 305
DAYTONA BEACH FL
32117-5515
US

IV. Provider business mailing address

1673 MASON AVE SUITE# 305
DAYTONA BEACH FL
32117-5515
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-7118
  • Fax: 386-274-6173
Mailing address:
  • Phone: 386-274-7118
  • Fax: 386-274-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME 72167
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME 72167
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME 72167
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number109338
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME 72167
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME 72167
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101284576
License Number StateVA
# 8
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME72167
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME 72167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: