Individual
MR. ETHAN TADD LEVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
3001 N ROCKY POINT DR E, TAMPA, FL 33607-5810
(813) 289-9613
Mailing address
175 2ND ST S, # 1007, SAINT PETERSBURG, FL 33701-4314
(352) 514-3270
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103772
FL
Other
Enumeration date
12/28/2007
Last updated
12/28/2007
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