Provider Demographics
NPI:1336187582
Name:LEVINE, GARY MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARC
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7627
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0627
Mailing Address - Country:US
Mailing Address - Phone:251-316-3868
Mailing Address - Fax:251-316-3583
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR
Practice Address - Street 2:SUITE 1E
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-316-3868
Practice Address - Fax:251-316-3583
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL278152085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051546592OtherBCBS-RTO
AL16-01005OtherUNITED HEALTHCARE
AL1340789OtherHEALTHSPRING - PET
FL269875700Medicaid
AL009936627Medicaid
AL51519209OtherBCBS
AL009914261Medicaid
AL009940055Medicaid
AL0515-47157OtherBCBS - PAM
MS05754501Medicaid
AL009914128Medicaid
AL1341150OtherHEALTHSPRING - PAM
AL009914154Medicaid
AL051547148OtherBCBS - PET
AL1341151OtherHEALTHSPRING - RTO
LA1655121Medicaid
AL16-01005OtherUNITED HEALTHCARE
E82515Medicare UPIN
FL269875700Medicaid
MS05754501Medicaid
AL009940055Medicaid