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General NPI Number Information
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NPI Number | 1447073028
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Entity Type | Organization
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Legal Business Name | JEFFREY M LEVINE MD LLC
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 10200 SW EASTRIDGE ST STE 220
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City | PORTLAND
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State | OR
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Zip | 97225-5029
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Country | US
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Telephone | 971-291-2662
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Fax | 503-954-3420
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Provider Business Mailing Address
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Address Line | 10200 SW EASTRIDGE ST STE 220
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City | PORTLAND
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State | OR
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Zip | 97225-5029
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Country | US
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Telephone | 971-291-2662
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Fax | 503-954-3420
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Authorized Official
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Title or Position | MD/OWNER
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Name | JEFFREY MARK LEVINE
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Credential | MD
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Telephone | 971-291-2662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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