Provider Demographics
NPI:1548283393
Name:LEVINE, JONATHAN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 N FEDERAL HWY
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4618
Mailing Address - Country:US
Mailing Address - Phone:954-202-0242
Mailing Address - Fax:954-202-0243
Practice Address - Street 1:4801 N FEDERAL HWY
Practice Address - Street 2:SUITE # 101
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4618
Practice Address - Country:US
Practice Address - Phone:954-202-0242
Practice Address - Fax:954-202-0243
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 42654208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001401391OtherUNITED HEALTH CARE
FL1711423OtherCIGNA
FL243332OtherAVMED
FL374861800Medicaid
FL001401391OtherUNITED HEALTH CARE
FL374861800Medicaid