MEDICARE: DR. JOSEPH E 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	207T00000X	Neurological Surgery Physician	ME40581	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376528000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH E LEVINE M.D.

Provider Business Mailing Address
First Line	:	1005 MAR WALT DR
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6707
Country	:	US
Telephone Number	:	850-863-8100
Fax Number	:	850-862-2302

Provider Business Practice Location Address
First Line	:	1106 HOSPITAL RD
Second Line	:	NEUROLOGICAL SURGERY DEPARTMENT
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6742
Country	:	US
Telephone Number	:	850-863-8291
Fax Number	:	850-863-7045

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	10/07/2011

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