1346472461 NPI number — DR. DANIEL RAPHAEL LEVINSON M.D.

Table of content: DR. DANIEL RAPHAEL LEVINSON M.D. (NPI 1346472461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346472461 NPI number — DR. DANIEL RAPHAEL LEVINSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVINSON
Provider First Name:
DANIEL
Provider Middle Name:
RAPHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEVINSON
Provider Other First Name:
DANIEL
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346472461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CHILDRENS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-454-6173
Provider Business Mailing Address Fax Number:
314-454-2412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CHILDREN'S PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-454-6173
Provider Business Practice Location Address Fax Number:
314-454-2412
Provider Enumeration Date:
08/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0206X , with the licence number:  2009010073 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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