Provider Demographics
NPI:1689679649
Name:LEVINE, ALAN MARK (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:MARK
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6132 KIPPS COLONY DR W
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3970
Mailing Address - Country:US
Mailing Address - Phone:727-260-1040
Mailing Address - Fax:727-347-3135
Practice Address - Street 1:1501 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-3717
Practice Address - Country:US
Practice Address - Phone:727-938-8806
Practice Address - Fax:727-934-6370
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME60028207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054625900Medicaid
FL14954AMedicare ID - Type Unspecified