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General NPI Number Information
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NPI Number | 1639576903
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Entity Type | Organization
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Legal Business Name | MSONTHI B, LEVINE, PA
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 3560 DELAWARE ST STE 1104
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City | BEAUMONT
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State | TX
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Zip | 77706-3000
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Country | US
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Telephone | 409-346-3721
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Fax | 409-860-9078
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Provider Business Mailing Address
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Address Line | 3560 DELAWARE ST STE 1104
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City | BEAUMONT
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State | TX
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Zip | 77706-3000
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Country | US
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Telephone | 409-346-3721
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Fax | 409-860-9078
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Authorized Official
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Title or Position | OWNER
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Name | MSONTHI B LEVINE
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Credential | MD
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Telephone | 409-347-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP125323
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | K8650
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License Number State | TX
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