Provider Demographics
NPI:1770520066
Name:LEVY, NEIL STANTON (DO)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:STANTON
Last Name:LEVY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:NEIL
Other - Middle Name:S
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:12531 RENOIR LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1749
Mailing Address - Country:US
Mailing Address - Phone:469-802-9556
Mailing Address - Fax:
Practice Address - Street 1:12531 RENOIR LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1749
Practice Address - Country:US
Practice Address - Phone:469-802-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6960208000000X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135083710Medicaid
TX10028436Medicaid
TX135083709Medicaid
TX135083710Medicaid
TX135083709Medicaid