Healthcare Provider Details

I. General information

NPI: 1114914249
Provider Name (Legal Business Name): DAVID ALAN LEVINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4957 38TH AVE N STE B
ST PETERSBURG FL
33710-2174
US

IV. Provider business mailing address

4957 38TH AVE N STE B
ST PETERSBURG FL
33710-2174
US

V. Phone/Fax

Practice location:
  • Phone: 727-522-8878
  • Fax: 727-521-1192
Mailing address:
  • Phone: 727-522-8878
  • Fax: 727-521-1192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME51828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: