Provider Demographics
NPI:1356333199
Name:LEVY, WALTER E III (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:E
Last Name:LEVY
Suffix:III
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 1:4224 HOUMA BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2933
Mailing Address - Country:US
Mailing Address - Phone:504-454-0755
Mailing Address - Fax:504-780-2558
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-454-0755
Practice Address - Fax:504-780-2558
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013245174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1311596Medicaid
LAB64562Medicare UPIN
LA1311596Medicaid