Provider Demographics
NPI:1497850937
Name:LEVY, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12855 N 40 DR STE 375
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8657
Mailing Address - Country:US
Mailing Address - Phone:314-567-6071
Mailing Address - Fax:314-434-1277
Practice Address - Street 1:112 PIPER HILL DR
Practice Address - Street 2:STE 12
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1690
Practice Address - Country:US
Practice Address - Phone:636-939-9202
Practice Address - Fax:636-939-9113
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3F63208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100936OtherHEALTHLINK
MO202433215Medicaid
MO25970OtherBLUE CROSS BLUE SHIELD
MOP1744193OtherAFFORDABLE
MO1900036OtherUNITED HEALTHCARE/MED COM
MO42193OtherGHP/ADVANTRA/CMR
MO42193OtherCIGNA
MO1900036OtherUNITED HEALTHCARE/MED COM
MO42193OtherGHP/ADVANTRA/CMR