Healthcare Provider Details

I. General information

NPI: 1669649505
Provider Name (Legal Business Name): ROBERT ISAAC LEVY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2099 NW PINE TREE WAY
STUART FL
34994-8829
US

IV. Provider business mailing address

2099 NW PINE TREE WAY
STUART FL
34994-8829
US

V. Phone/Fax

Practice location:
  • Phone: 772-341-0695
  • Fax:
Mailing address:
  • Phone: 772-341-0695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS4418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: