MEDICARE: BRUCE J LEVINE DPM PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	213ES0131X	Foot Surgery Podiatrist
4	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1932068939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE J LEVINE DPM PA

Provider Business Mailing Address
First Line	:	PO BOX 825159
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-5159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 DEL PRADO BLVD S STE 12
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-5523
Country	:	US
Telephone Number	:	239-573-9200
Fax Number	:	855-376-5040

Authorized Official
Title or Position	:	OWNER
Name	:	ROY CLINT LAIRD
Credential	:
Telephone Number	:	941-493-8666

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/20/2026

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