Provider Demographics
NPI:1871721670
Name:LEVY, MARCOS (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 GOLF CLUB RD APT 101
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1647
Mailing Address - Country:US
Mailing Address - Phone:954-793-0358
Mailing Address - Fax:954-349-9707
Practice Address - Street 1:16100 GOLF CLUB RD APT 101
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1647
Practice Address - Country:US
Practice Address - Phone:954-793-0358
Practice Address - Fax:954-349-9707
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL08-188363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08-188OtherSURGICAL ASSISTANT CERTFICATION