Clive Levine, M.D.

Individual provider Active NPI General Practice Physician · Santa Fe, NM

NPI 1275976284 · NPPES record last updated Apr 9, 2013

Key facts

NPI
1275976284
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Physician 208D00000X
License
R8936 (MO)
Practice address
508 Los Nidos Dr
Santa Fe, NM 87501-8356
Phone
(505) 989-3790
NPI assigned
Apr 9, 2013
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X R8936 MO Yes

Addresses

Primary practice location

508 Los Nidos Dr
Santa Fe, NM 87501-8356

Mailing address

508 Los Nidos Dr
Santa Fe, NM 87501-8356
Phone (505) 989-3790

Other providers in Santa Fe, NM

All providers in Santa Fe, NM · General Practice Physician in New Mexico

Sources for this page

Verify at the official NPI Registry.