Provider Demographics
NPI:1053415430
Name:LEVIN, DENNIS L (MD)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:L
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6013
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-6013
Mailing Address - Country:US
Mailing Address - Phone:530-889-6300
Mailing Address - Fax:530-889-6303
Practice Address - Street 1:3227 PROFESSIONAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602
Practice Address - Country:US
Practice Address - Phone:530-889-6300
Practice Address - Fax:530-889-6303
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG36601OtherLICENSE
CAG36601OtherLICENSE