Provider Demographics
NPI:1376528000
Name:LEVINE, JOSEPH E (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8100
Mailing Address - Fax:850-862-2302
Practice Address - Street 1:1106 HOSPITAL RD
Practice Address - Street 2:NEUROLOGICAL SURGERY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6742
Practice Address - Country:US
Practice Address - Phone:850-863-8291
Practice Address - Fax:850-863-7045
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME40581207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066861300Medicaid
D54962Medicare UPIN
FL46144ZMedicare ID - Type Unspecified