MEDICARE: DR. BRYAN LEVY D.O.

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	5101021893	MI
2	208600000X	Surgery Physician	DR.0065455	CO

General Provider Information

NPI Number	:	1336522820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN LEVY D.O.

Provider Business Mailing Address
First Line	:	2030 MOUNTAIN VIEW AVE STE 200
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3180
Country	:	US
Telephone Number	:	720-652-8444
Fax Number	:	720-652-8445

Provider Business Practice Location Address
First Line	:	2030 MOUNTAIN VIEW AVE STE 200
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3180
Country	:	US
Telephone Number	:	720-652-8444
Fax Number	:	720-652-8445

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

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	01/10/2022

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Directions to “ DR. BRYAN LEVY D.O.” Practice Location

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