MEDICARE: BRIAN J LEVINE MD

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	36043	AZ

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	36043	OTHER	AZ	AZ MEDICAL LIC

General Provider Information

NPI Number	:	1881814549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN J LEVINE MD

Provider Business Mailing Address
First Line	:	PO BOX 43160
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85733-3160
Country	:	US
Telephone Number	:	520-722-3777
Fax Number	:	520-296-6224

Provider Business Practice Location Address
First Line	:	1712 W ANKLAM RD
Second Line	:	SUITE 103
City	:	TUCSON
State	:	AZ
Zip	:	85745-2660
Country	:	US
Telephone Number	:	520-622-7384
Fax Number	:	520-622-4899

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	01/20/2009

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