Provider Demographics
NPI:1306067814
Name:LEVY, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21137 STATE ROUTE 410 E STE I
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8775
Mailing Address - Country:US
Mailing Address - Phone:253-862-5275
Mailing Address - Fax:855-673-1403
Practice Address - Street 1:21137 STATE ROUTE 410 E STE I
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8775
Practice Address - Country:US
Practice Address - Phone:253-862-5275
Practice Address - Fax:855-673-1403
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60014608207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology