Provider Demographics
NPI:1528031408
Name:LEVENSON, JEFFREY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:LEVENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 66TH ST N
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5544
Mailing Address - Country:US
Mailing Address - Phone:727-384-2479
Mailing Address - Fax:727-384-3573
Practice Address - Street 1:1700 66TH ST N
Practice Address - Street 2:SUITE 510
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5544
Practice Address - Country:US
Practice Address - Phone:727-384-2479
Practice Address - Fax:727-384-3573
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055609207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257401200Medicaid
FL257401200Medicaid
FL12820ZMedicare ID - Type UnspecifiedMEDICARE