Healthcare Provider Details

I. General information

NPI: 1235104704
Provider Name (Legal Business Name): BRUCE A LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 COLUMBIA ST STE 500
ORLANDO FL
32806-1115
US

IV. Provider business mailing address

60 COLUMBIA ST STE 500
ORLANDO FL
32806-1115
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5851
  • Fax: 407-423-1380
Mailing address:
  • Phone: 321-843-5851
  • Fax: 407-423-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME162207
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number37430
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME162207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: