Provider Demographics
NPI:1265441521
Name:LEVIN, DAVID REECE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REECE
Last Name:LEVIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18055 BUSHARD ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5760
Mailing Address - Country:US
Mailing Address - Phone:714-968-4474
Mailing Address - Fax:949-493-4252
Practice Address - Street 1:18055 BUSHARD ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5760
Practice Address - Country:US
Practice Address - Phone:714-968-4474
Practice Address - Fax:949-493-4252
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2850213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE2850Medicare PIN