Provider Demographics
NPI:1720180920
Name:LEVERETT, CARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:L
Last Name:LEVERETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARY
Other - Middle Name:L
Other - Last Name:LEVERETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:548 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-625-2229
Mailing Address - Fax:830-629-9215
Practice Address - Street 1:876 LOOP 337
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-625-2229
Practice Address - Fax:830-629-9215
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8015208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B24368Medicare UPIN