Provider Demographics
NPI:1679686950
Name:LEVY, JEFFREY A (MD PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DIPLOMAT PKWY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2234
Mailing Address - Country:US
Mailing Address - Phone:954-483-4160
Mailing Address - Fax:305-937-4888
Practice Address - Street 1:1600 DIPLOMAT PKWY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2234
Practice Address - Country:US
Practice Address - Phone:954-483-4160
Practice Address - Fax:305-937-4888
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053799207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273741800Medicaid
FL09916Medicare ID - Type Unspecified
E59518Medicare UPIN
FL273741800Medicaid