Provider Demographics
NPI:1447274535
Name:LEVY, ROGER A (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WEST BOCA
Other - Middle Name:WELLNESS
Other - Last Name:CTR P.A.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9980 CENTRAL PARK BLVD N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1762
Mailing Address - Country:US
Mailing Address - Phone:561-487-0550
Mailing Address - Fax:561-883-2639
Practice Address - Street 1:9980 CENTRAL PARK BLVD N
Practice Address - Street 2:SUITE 104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1762
Practice Address - Country:US
Practice Address - Phone:561-487-0550
Practice Address - Fax:561-883-2639
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96179OtherBLUE CROSS
FLD63761Medicare UPIN
FL96179OtherBLUE CROSS