Individual
MARK LEVITAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 W 38TH ST, SUITE 200, AUSTIN, TX 78705-1169
(512) 451-0103
(512) 451-2741
Mailing address
801 W 38TH ST, SUITE 200, AUSTIN, TX 78705-1169
(512) 451-0103
(512) 451-2741
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
J3839
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
J3839
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116713204
—
TX
05
—
116713205
—
TX
01
—
180044339
RAILROAD MEDICARE
TX
01
—
8G5370
BCBS TX
TX
Enumeration date
02/06/2006
Last updated
05/04/2017
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