Provider Demographics
NPI:1982673745
Name:LEVINE, DONALD JACOCKS (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JACOCKS
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:30 ARDISIA LANE
Practice Address - Street 2:
Practice Address - City:ST. JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:904-287-2794
Practice Address - Fax:904-390-7458
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2022-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0069268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00469532OtherRR MEDICARE
FLP00469532OtherRR MEDICARE