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General NPI Number Information
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NPI Number | 1932068939
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Entity Type | Organization
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Legal Business Name | BRUCE J LEVINE DPM PA
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 1722 DEL PRADO BLVD S STE 12
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City | CAPE CORAL
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State | FL
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Zip | 33990-5523
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Country | US
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Telephone | 239-573-9200
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Fax | 855-376-5040
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Provider Business Mailing Address
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Address Line | PO BOX 825159
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5159
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROY CLINT LAIRD
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Credential |
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Telephone | 941-493-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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