Provider Demographics
NPI:1760634661
Name:BRUCE ANDREW LEVY MD PA
Entity Type:Organization
Organization Name:BRUCE ANDREW LEVY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-796-9100
Mailing Address - Street 1:6410 FANNIN ST
Mailing Address - Street 2:SUITE 1460
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5308
Mailing Address - Country:US
Mailing Address - Phone:713-796-9100
Mailing Address - Fax:713-796-9110
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:SUITE 1460
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5308
Practice Address - Country:US
Practice Address - Phone:713-796-9100
Practice Address - Fax:713-796-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0982290-01Medicaid
TX00F05KMedicare PIN
TX0982290-01Medicaid