Provider Demographics
NPI:1780888263
Name:LEVENS, GERALD FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:FRANK
Last Name:LEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERRY
Other - Middle Name:FRANK
Other - Last Name:LEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1175 CREEKSIDE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2068
Mailing Address - Country:US
Mailing Address - Phone:239-284-4333
Mailing Address - Fax:239-260-5036
Practice Address - Street 1:1175 CREEKSIDE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108
Practice Address - Country:US
Practice Address - Phone:239-284-4333
Practice Address - Fax:239-260-5036
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98854202C00000X, 207Q00000X
FL98854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME98854OtherMEDICAL LICENSE