Provider Demographics
NPI:1316176464
Name:LEVINGSTON, KORY D
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:D
Last Name:LEVINGSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 FAYE ST
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5509
Mailing Address - Country:US
Mailing Address - Phone:214-497-5302
Mailing Address - Fax:
Practice Address - Street 1:2407 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210-1951
Practice Address - Country:US
Practice Address - Phone:214-497-5302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies