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General NPI Number Information
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NPI Number | 1972759371
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Entity Type | Organization
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Legal Business Name | REBECCA LEVINE, MD, PLLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1575 W 7000 S
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City | WEST JORDAN
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State | UT
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Zip | 84084-3431
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Country | US
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Telephone | 801-569-9113
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Fax | 801-569-9103
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Provider Business Mailing Address
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Address Line | PO BOX 413008
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City | SALT LAKE CITY
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State | UT
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Zip | 84141-0001
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Country | US
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Telephone | 801-569-9119
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Fax | 801-569-9103
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Authorized Official
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Title or Position | OWNER / MD
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Name | REBECCA LEVINE
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Credential | MD
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Telephone | 801-569-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33292020-1205
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License Number State | UT
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