Provider Demographics
NPI:1205897576
Name:LEVASSEUR, JOHN GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGORY
Last Name:LEVASSEUR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5282 MEDICAL DR STE 518
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6046
Mailing Address - Country:US
Mailing Address - Phone:210-615-8200
Mailing Address - Fax:210-615-8220
Practice Address - Street 1:5282 MEDICAL DR STE 518
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6046
Practice Address - Country:US
Practice Address - Phone:210-615-8200
Practice Address - Fax:210-615-8220
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-06-25
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Provider Licenses
StateLicense IDTaxonomies
TXN5190207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L73LMedicare PIN