Provider Demographics
NPI:1023118379
Name:LEVENSON, JEFFREY HERSCHEL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HERSCHEL
Last Name:LEVENSON
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 1:751 OAK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3361
Mailing Address - Country:US
Mailing Address - Phone:904-366-3781
Mailing Address - Fax:
Practice Address - Street 1:751 OAK ST STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3361
Practice Address - Country:US
Practice Address - Phone:904-366-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052225207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07299WOtherMEDICARE ID
FL261362000Medicaid
FL4116210001Medicare NSC
FLD51896Medicare UPIN