Provider Demographics
NPI:1164671632
Name:LEVINE, JAPERA N (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAPERA
Middle Name:N
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 EXECUTIVE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-1000
Mailing Address - Country:US
Mailing Address - Phone:409-833-3668
Mailing Address - Fax:409-833-3667
Practice Address - Street 1:3155 EXECUTIVE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-1000
Practice Address - Country:US
Practice Address - Phone:409-833-3668
Practice Address - Fax:409-833-3667
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2037213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329829101Medicaid
TX1164671632Medicaid