Provider Demographics
NPI:1528041142
Name:LEVIN, BRUCE B (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:B
Last Name:LEVIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24863
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-4863
Mailing Address - Country:US
Mailing Address - Phone:480-967-6500
Mailing Address - Fax:480-967-6540
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-977-9100
Practice Address - Fax:623-977-8020
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0584213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ792243Medicaid
AZ792243Medicaid
AZ119692Medicare PIN
AZT44760Medicare UPIN