MEDICARE: DR. IRA JAY LEVINE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	D39986	MD

General Provider Information

NPI Number	:	1053342584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA JAY LEVINE M.D.

Provider Business Mailing Address
First Line	:	5695 PALOMINO CT
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59602-6005
Country	:	US
Telephone Number	:	406-458-4863
Fax Number	:

Provider Business Practice Location Address
First Line	:	3687 VETERANS DRIVE
Second Line	:	VA MONTANA
City	:	FORT HARRISON
State	:	MT
Zip	:	59636
Country	:	US
Telephone Number	:	406-442-6410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	09/23/2016

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