Provider Demographics
NPI:1841258621
Name:LEVIN, DONALD (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:LEVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:208-814-7491
Practice Address - Street 1:21 E MAPLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-4900
Practice Address - Country:US
Practice Address - Phone:208-788-3200
Practice Address - Fax:208-788-3386
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-14207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP00434702OtherRR MEDICARE
ID002498800Medicaid
IDP01032140OtherMCRR
ID13003811Medicare PIN
IDP00381061Medicare PIN
ID002498800Medicaid
ID13003812Medicare PIN
ID1300388Medicare PIN