Provider Demographics
NPI:1275577793
Name:LEVEQUE, ERIC A (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:LEVEQUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28951
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8951
Mailing Address - Country:US
Mailing Address - Phone:888-398-1370
Mailing Address - Fax:
Practice Address - Street 1:1303 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3309
Practice Address - Country:US
Practice Address - Phone:559-450-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8385207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0020A83850OtherBLUE SHIELD
CA00AX83850Medicaid
CA20A8385OtherBLUE CROSS
20A8385OtherCOUNTY OF FRESNO
CA20A8385OtherBLUE CROSS
CA143038Medicare UPIN
CA00AX83850Medicaid
CR0087Medicare PIN
020A83851Medicare PIN