Individual
DR. DONALD JACOCKS LEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 ARDISIA LANE, ST. JOHNS, FL 32259
(904) 287-2794
(904) 390-7458
Mailing address
PO BOX 746638, ATLANTA, GA 30374-6638
(904) 202-1032
(904) 376-4107
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0069268
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00469532
RR MEDICARE
FL
Enumeration date
03/15/2006
Last updated
09/09/2022
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