Provider Demographics
NPI:1649535980
Name:CRUCE, LEVON RAY (CP BOCPO)
Entity type:Individual
Prefix:MR
First Name:LEVON
Middle Name:RAY
Last Name:CRUCE
Suffix:
Gender:M
Credentials:CP BOCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 MCFADDIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1921
Mailing Address - Country:US
Mailing Address - Phone:337-244-3011
Mailing Address - Fax:
Practice Address - Street 1:2473 MCFADDIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1921
Practice Address - Country:US
Practice Address - Phone:337-244-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist