Provider Demographics
NPI:1114914249
Name:LEVINE, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4957 38TH AVE N
Mailing Address - Street 2:STE B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2174
Mailing Address - Country:US
Mailing Address - Phone:727-522-8878
Mailing Address - Fax:727-521-1192
Practice Address - Street 1:4957 38TH AVE N
Practice Address - Street 2:STE B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2174
Practice Address - Country:US
Practice Address - Phone:727-522-8878
Practice Address - Fax:727-521-1192
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51828207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07794OtherBCBS
FL038968400Medicaid
E22424Medicare UPIN
FL07794OtherBCBS