Provider Demographics
NPI:1689470122
Name:RUSS L LEVITAN MD INC
Entity type:Organization
Organization Name:RUSS L LEVITAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-550-0445
Mailing Address - Street 1:1305 FILAREE WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-4947
Mailing Address - Country:US
Mailing Address - Phone:805-550-0445
Mailing Address - Fax:805-782-8097
Practice Address - Street 1:10 SANTA ROSA ST # 201
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5826
Practice Address - Country:US
Practice Address - Phone:805-544-7246
Practice Address - Fax:805-782-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty