Provider Demographics
NPI:1437342847
Name:LEVY-CLARKE, GRACE ANGELA (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANGELA
Last Name:LEVY-CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 N MCMULLEN BOOTH RD UNIT 764
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-9630
Mailing Address - Country:US
Mailing Address - Phone:727-317-5830
Mailing Address - Fax:888-539-6488
Practice Address - Street 1:11809 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3505
Practice Address - Country:US
Practice Address - Phone:727-317-5830
Practice Address - Fax:888-412-1795
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99689207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280096900Medicaid
FL09283OtherBCBS
FL280096900Medicaid
FLAF420XMedicare PIN
FL09283OtherBCBS