Provider Demographics
NPI:1386877884
Name:CARY LEVERETT MD PA
Entity type:Organization
Organization Name:CARY LEVERETT MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MANSEL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-625-8088
Mailing Address - Street 1:876 LOOP 337 STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3553
Mailing Address - Country:US
Mailing Address - Phone:830-625-8088
Mailing Address - Fax:830-629-9215
Practice Address - Street 1:876 LOOP 337 STE 302
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3553
Practice Address - Country:US
Practice Address - Phone:830-625-8088
Practice Address - Fax:830-629-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039BMMedicare PIN