Provider Demographics
NPI:1700995537
Name:BRUCE J LEVINE DPM PA
Entity Type:Organization
Organization Name:BRUCE J LEVINE DPM PA
Other - Org Name:FOOT & ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-797-5008
Mailing Address - Street 1:2521 COUNTRYSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1605
Mailing Address - Country:US
Mailing Address - Phone:727-797-5008
Mailing Address - Fax:727-791-8517
Practice Address - Street 1:2521 COUNTRYSIDE BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1605
Practice Address - Country:US
Practice Address - Phone:727-797-5008
Practice Address - Fax:727-791-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1802213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCL7309OtherRAILROAD MEDICARE
FL33537Medicare PIN
FLCL7309OtherRAILROAD MEDICARE