Provider Demographics
NPI:1144261637
Name:LEVINSON, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4000 CIVIC CENTER DR.
Mailing Address - Street 2:STE 206
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:415-925-8865
Mailing Address - Fax:415-446-0134
Practice Address - Street 1:SANTA ROSA MEMORIAL HOSPITAL
Practice Address - Street 2:1165 MONTGOMERY DRIVE
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4897
Practice Address - Country:US
Practice Address - Phone:707-522-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2021-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA71459207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH24599Medicare UPIN
CA00A714590Medicare ID - Type Unspecified