Basic Information
| Provider Information | |||||||||
| NPI: | 1740290485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVIN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | RUBIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 STANDIFORD AVE | ||||||||
| Address2: | STE F | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953501159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095795628 | ||||||||
| FaxNumber: | 2095795637 | ||||||||
| Practice Location | |||||||||
| Address1: | 1541 FLORIDA AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953504429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095210767 | ||||||||
| FaxNumber: | 2095215204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 03/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | JL053156 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 130014307 | 01 | MI | PALMETTO | OTHER | 1307311791 | 01 | MI | BLUE CROSS | OTHER | A46304 | 01 | CA | MEDICAL LICENSE | OTHER | 307646010 | 05 | MI | MEDICAID | 1300926612 | 01 | MI | HEALTHPLUS | OTHER |