Provider Demographics
NPI:1760431225
Name:LEVY, ERNESTO N (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:N
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERNESTO
Other - Middle Name:
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1015 N SHARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1021
Mailing Address - Country:US
Mailing Address - Phone:405-606-8070
Mailing Address - Fax:
Practice Address - Street 1:1015 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1021
Practice Address - Country:US
Practice Address - Phone:405-606-8070
Practice Address - Fax:405-606-6350
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83470207RR0500X
PAMD423583207RR0500X
NY263037207RR0500X
MEMD23773207RR0500X
MO100125207RR0500X
AZ55071207RR0500X
IN01064370A207RR0500X
OK40813207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008690920001Medicaid
G11782Medicare UPIN
PA1008690920001Medicaid