Healthcare Provider Details

I. General information

NPI: 1619397635
Provider Name (Legal Business Name): ROBERT EVAN LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 CORNELISON RD
CHATTANOOGA TN
37411-5661
US

IV. Provider business mailing address

5715 CORNELISON RD
CHATTANOOGA TN
37411-5661
US

V. Phone/Fax

Practice location:
  • Phone: 423-892-3937
  • Fax:
Mailing address:
  • Phone: 205-862-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number58984
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number58984
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number58984
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: