Provider Demographics
NPI:1770833857
Name:LEVANT, JONATHAN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALAN
Last Name:LEVANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3201 PACIFIC AVE
Mailing Address - Street 2:UNIT 1108
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-6907
Mailing Address - Country:US
Mailing Address - Phone:253-208-9456
Mailing Address - Fax:253-476-0166
Practice Address - Street 1:3201 PACIFIC AVE
Practice Address - Street 2:UNIT 1108
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-6907
Practice Address - Country:US
Practice Address - Phone:253-208-9456
Practice Address - Fax:253-476-0166
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00013066207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology