Provider Demographics
NPI:1194808063
Name:LEVENSON, DAVID I (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:I
Last Name:LEVENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:I
Other - Last Name:LEVENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7301 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 108B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3458
Mailing Address - Country:US
Mailing Address - Phone:561-391-4441
Mailing Address - Fax:561-391-4450
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 108B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3458
Practice Address - Country:US
Practice Address - Phone:561-391-4441
Practice Address - Fax:561-391-4450
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59003174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME59003OtherMEDICAL LICENSE