Provider Demographics
NPI:1124321765
Name:LEVY, LARRY D (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2301 YALE BLVD SE
Mailing Address - Street 2:SUITE D3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4228
Mailing Address - Country:US
Mailing Address - Phone:505-842-4433
Mailing Address - Fax:505-842-4436
Practice Address - Street 1:2301 YALE BLVD SE
Practice Address - Street 2:SUITE D3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4228
Practice Address - Country:US
Practice Address - Phone:505-842-4433
Practice Address - Fax:505-842-4436
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM83-238207P00000X
TXJ4893207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME81815Medicare UPIN