Healthcare Provider Details

I. General information

NPI: 1265887079
Provider Name (Legal Business Name): DAVID A LEVINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 PGA BLVD STE 350
PALM BEACH GARDENS FL
33410-2831
US

IV. Provider business mailing address

3399 PGA BLVD STE 350
PALM BEACH GARDENS FL
33410-2831
US

V. Phone/Fax

Practice location:
  • Phone: 561-624-0099
  • Fax: 561-624-7373
Mailing address:
  • Phone: 561-624-0099
  • Fax: 561-624-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number8603
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME152860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: