Provider Demographics
NPI:1225019904
Name:LEVINE, JASON M (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
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 1:6422 E SPEEDWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1151
Mailing Address - Country:US
Mailing Address - Phone:520-327-3487
Mailing Address - Fax:520-327-3488
Practice Address - Street 1:6422 E SPEEDWAY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1151
Practice Address - Country:US
Practice Address - Phone:520-327-3487
Practice Address - Fax:520-327-3488
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28954207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ712423Medicaid
AZ712423Medicaid
AZZ81284Medicare ID - Type Unspecified