Healthcare Provider Details

I. General information

NPI: 1508007790
Provider Name (Legal Business Name): LEVY DERMATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 KIRBY PKWY STE 204
GERMANTOWN TN
38138-3697
US

IV. Provider business mailing address

1920 KIRBY PKWY STE 204
GERMANTOWN TN
38138-3697
US

V. Phone/Fax

Practice location:
  • Phone: 901-624-3333
  • Fax: 901-624-1203
Mailing address:
  • Phone: 901-624-3333
  • Fax: 901-624-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD0000043501
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD0000043501
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD0000043501
License Number StateTN

VIII. Authorized Official

Name: DR. ALAN LOUIS LEVY
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 901-682-0430