Provider Demographics
NPI:1851479505
Name:LEVY, MAURICE DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:DOUGLAS
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 NW 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2941
Mailing Address - Country:US
Mailing Address - Phone:352-338-3591
Mailing Address - Fax:352-338-3591
Practice Address - Street 1:2281 NW 24TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-2941
Practice Address - Country:US
Practice Address - Phone:352-338-3591
Practice Address - Fax:352-338-3591
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLL617208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003806600Medicaid
FLBL9611458OtherDEA
FLFC2912Medicare PIN