Provider Demographics
NPI:1023001781
Name:LEVY, JOE S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:S
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:SIMON
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5575 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3863
Mailing Address - Country:US
Mailing Address - Phone:901-682-0430
Mailing Address - Fax:901-680-0363
Practice Address - Street 1:5575 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3863
Practice Address - Country:US
Practice Address - Phone:901-682-0430
Practice Address - Fax:901-680-0363
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2016-02-22
Deactivation Date:2006-03-29
Deactivation Code:
Reactivation Date:2006-04-14
Provider Licenses
StateLicense IDTaxonomies
TNMD0000005887207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN030000450OtherRAILROAD MEDICARE
TNB02428Medicare UPIN