Provider Demographics
NPI:1083749642
Name:LEVINE, JASON C (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:LEVINE
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:PO BOX 12868
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-2868
Mailing Address - Country:US
Mailing Address - Phone:727-824-3139
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:620 10TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-824-8243
Practice Address - Fax:727-824-8233
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99461207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01217304OtherRAILROAD MEDICARE PROVIDER NUMBER
FL278949300Medicaid
FLP01217304OtherRAILROAD MEDICARE PROVIDER NUMBER
AE549XMedicare PIN