Provider Demographics
NPI:1326131707
Name:LEVINGER, LAURENCE W (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:W
Last Name:LEVINGER
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 1:2805 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1403
Mailing Address - Country:US
Mailing Address - Phone:541-523-7706
Mailing Address - Fax:541-523-6385
Practice Address - Street 1:2805 10TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1403
Practice Address - Country:US
Practice Address - Phone:541-523-7706
Practice Address - Fax:541-523-6385
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11285208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005470Medicaid
C93145Medicare UPIN
OR005470Medicaid