Provider Demographics
NPI:1558350975
Name:LEVY, RONALD MARK (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:MARK
Last Name:LEVY
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:PO BOX 740177
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33474-0177
Mailing Address - Country:US
Mailing Address - Phone:561-434-0060
Mailing Address - Fax:561-434-0598
Practice Address - Street 1:6944 LAKE WORTH RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2948
Practice Address - Country:US
Practice Address - Phone:561-434-0060
Practice Address - Fax:561-434-0598
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME100665207RG0100X
IL036111091207R00000X
IN01060271A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INA41449Medicare UPIN