Provider Demographics
NPI:1639268048
Name:LEVISON, MARC ALAN (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ALAN
Last Name:LEVISON
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 1:9626 E ADOBE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4401
Mailing Address - Country:US
Mailing Address - Phone:480-585-4961
Mailing Address - Fax:602-943-4808
Practice Address - Street 1:9327 N 3RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2470
Practice Address - Country:US
Practice Address - Phone:602-870-2014
Practice Address - Fax:602-943-4808
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ205722086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ068123Medicaid
AZMD2392Medicare PIN
AZB45377Medicare UPIN