Healthcare Provider Details

I. General information

NPI: 1346472461
Provider Name (Legal Business Name): DANIEL RAPHAEL LEVINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL R LEVINSON M.D.

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDREN'S PLACE
ST LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6173
  • Fax: 314-454-2412
Mailing address:
  • Phone: 314-454-6173
  • Fax: 314-454-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number2009010073
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: