Provider Demographics
NPI:1174572531
Name:LEVINSON, LARRY K (DO)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:K
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SHERIDAN ST # A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3420
Mailing Address - Country:US
Mailing Address - Phone:954-964-1585
Mailing Address - Fax:954-964-4977
Practice Address - Street 1:4700 SHERIDAN ST # A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3420
Practice Address - Country:US
Practice Address - Phone:954-964-1585
Practice Address - Fax:954-964-4977
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 005489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049913700Medicaid
FL80062ZMedicare ID - Type Unspecified