Provider Demographics
NPI:1326030909
Name:LEVINE, JEFFREY SHELDON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SHELDON
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 1:1056 S VAL VISTA DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5667
Mailing Address - Country:US
Mailing Address - Phone:480-834-5480
Mailing Address - Fax:480-834-3194
Practice Address - Street 1:1056 S VAL VISTA DR
Practice Address - Street 2:SUITE #2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5667
Practice Address - Country:US
Practice Address - Phone:480-834-5480
Practice Address - Fax:480-834-3194
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2012-09-14
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
AZBL2176471207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE63382Medicare UPIN
AZZ61423Medicare ID - Type Unspecified