Provider Demographics
NPI:1417990557
Name:LEVITAN, PAUL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:LEVITAN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG B 203
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-674-3647
Mailing Address - Fax:760-674-3845
Practice Address - Street 1:151 S SUNRISE WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0118
Practice Address - Country:US
Practice Address - Phone:760-969-7780
Practice Address - Fax:760-969-7781
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-02-29
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Provider Licenses
StateLicense IDTaxonomies
CAG80263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF99612Medicare UPIN
CA00G802634Medicare ID - Type Unspecified