Provider Demographics
NPI:1801886783
Name:LEVY, RENNY H (MD)
Entity type:Individual
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First Name:RENNY
Middle Name:H
Last Name:LEVY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:2947 RODEO PARK DR E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6303
Practice Address - Country:US
Practice Address - Phone:505-983-6613
Practice Address - Fax:505-986-9984
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-04-25
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Provider Licenses
StateLicense IDTaxonomies
NM90-68207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ854027Medicaid
NMNM009539OtherBC BS OF NM
NM180042937OtherRRB MEDICARE RAILROAD
NM25672Medicaid
NM$$$$$$$$$TMedicare PIN
NMNM009539OtherBC BS OF NM