Provider Demographics
NPI:1790195287
Name:LEVINE, JASON EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDWARD
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:5555 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2513
Mailing Address - Country:US
Mailing Address - Phone:305-689-3636
Mailing Address - Fax:
Practice Address - Street 1:5555 PONCE DE LEON BLVD FL 3
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2513
Practice Address - Country:US
Practice Address - Phone:305-689-3636
Practice Address - Fax:305-243-6575
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3890213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist