Provider Demographics
NPI:1568473965
Name:LEVY, ROBERT LEE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPANOS CT
Mailing Address - Street 2:#134
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-529-2000
Mailing Address - Fax:209-525-3805
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:#134
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-529-2000
Practice Address - Fax:209-525-3805
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39275207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C392750Medicaid
A37099Medicare UPIN
CA00C392750Medicare ID - Type Unspecified