Provider Demographics
NPI:1134109325
Name:LEVIN, LARRY P (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:P
Last Name:LEVIN
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 1:673 LAKEWOODE CIR W
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4315
Mailing Address - Country:US
Mailing Address - Phone:561-865-0331
Mailing Address - Fax:
Practice Address - Street 1:1601 CLINT MOORE RD
Practice Address - Street 2:STE. 125
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2768
Practice Address - Country:US
Practice Address - Phone:561-939-0800
Practice Address - Fax:561-939-0820
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0048220207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02728OtherBLUE CROSS BLUE SHIELD
FL245357OtherAETNA
FLD50629Medicare UPIN
FL245357OtherAETNA