Basic Information
| Provider Information | |||||||||
| NPI: | 1497850937 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12855 N 40 DR STE 375 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631418657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145676071 | ||||||||
| FaxNumber: | 3144341277 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 PIPER HILL DR | ||||||||
| Address2: | STE 12 | ||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369399202 | ||||||||
| FaxNumber: | 6369399113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | R3F63 | MO | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.