Provider Demographics
NPI:1851403281
Name:LEVITAN, DAVID (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LEVITAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 E JOHNSON AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6036
Mailing Address - Country:US
Mailing Address - Phone:850-494-6400
Mailing Address - Fax:850-494-6075
Practice Address - Street 1:2120 E JOHNSON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6036
Practice Address - Country:US
Practice Address - Phone:850-494-6400
Practice Address - Fax:850-494-6075
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2690207P00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290220600Medicaid
FLS60180Medicare UPIN
FL290220600Medicaid