Healthcare Provider Details

I. General information

NPI: 1497360259
Provider Name (Legal Business Name): DAVID SCOTT LEVY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date: 09/16/2020
Reactivation Date: 11/18/2020

III. Provider practice location address

390 S CENTRAL AVE
UMATILLA FL
32784-9602
US

IV. Provider business mailing address

390 S CENTRAL AVE
UMATILLA FL
32784-9602
US

V. Phone/Fax

Practice location:
  • Phone: 352-669-3175
  • Fax:
Mailing address:
  • Phone: 352-669-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: