=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780888263
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERALD FRANK LEVENS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2007
-----------------------------------------------------
Last Update Date | 01/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1175 CREEKSIDE PKWY STE 200
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-284-4333
-----------------------------------------------------
Fax | 239-260-5036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1175 CREEKSIDE PKWY STE 200
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34108-2068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-284-4333
-----------------------------------------------------
Fax | 239-260-5036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202C00000X
-----------------------------------------------------
Taxonomy Name | Independent Medical Examiner Physician
-----------------------------------------------------
License Number | ME98854
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME98854
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 98854
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------