Healthcare Provider Details

I. General information

NPI: 1508444654
Provider Name (Legal Business Name): DAVID GORDON LEVIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14011 BEACH BLVD STE 120
JACKSONVILLE FL
32250-1695
US

IV. Provider business mailing address

330 CORPORATE WAY STE 200
ORANGE PARK FL
32073-6214
US

V. Phone/Fax

Practice location:
  • Phone: 904-223-6400
  • Fax: 833-578-1820
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-866-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS23391
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS23391
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS23391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: