Provider Demographics
NPI:1447073028
Name:JEFFREY M LEVINE MD LLC
Entity type:Organization
Organization Name:JEFFREY M LEVINE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-291-2662
Mailing Address - Street 1:10200 SW EASTRIDGE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5029
Mailing Address - Country:US
Mailing Address - Phone:971-291-2662
Mailing Address - Fax:503-954-3420
Practice Address - Street 1:10200 SW EASTRIDGE ST STE 220
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5029
Practice Address - Country:US
Practice Address - Phone:971-291-2662
Practice Address - Fax:503-954-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty