Provider Demographics
NPI:1497360259
Name:LEVY, DAVID SCOTT (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:LEVY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-9602
Mailing Address - Country:US
Mailing Address - Phone:352-669-3175
Mailing Address - Fax:
Practice Address - Street 1:390 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-9602
Practice Address - Country:US
Practice Address - Phone:352-669-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-11-19
Deactivation Date:2020-09-16
Deactivation Code:
Reactivation Date:2020-11-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical