Healthcare Provider Details

I. General information

NPI: 1871815548
Provider Name (Legal Business Name): DAVID J. LEVINE, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S WOODS MILL RD
CHESTERFIELD MO
63017-3662
US

IV. Provider business mailing address

226 S WOODS MILL RD
CHESTERFIELD MO
63017-3662
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6564
  • Fax: 314-576-2346
Mailing address:
  • Phone: 314-205-6564
  • Fax: 314-576-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR2B74
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID JAY LEVINE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 314-205-6564