Glenn Laurence Levine, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD162422 Issued in OR

Practice address

790 E 5TH St
Coquille, OR 97423

Phone

(541) 396-3111

Fax

(541) 396-5891

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: glevine1372088@oc.providencedirect.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1801814769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 E 5TH ST",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "97423",
            "telephone_number": "541-247-3000",
            "fax_number": "541-247-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 E 5TH ST",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "97423",
            "telephone_number": "541-396-3111",
            "fax_number": "541-396-5891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVINE",
        "first_name": "GLENN",
        "middle_name": "LAURENCE",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD162422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CURRY MEDICAL PRACTICE / CURRY MEDICAL CENTER MEDICARE PART B",
            "identifier": "R00000ZGBDG",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500662335",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CURRY HEALTH DISTRICT TAX IDN",
            "identifier": "93-0937095",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "glevine1372088@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4805 NE Glisan St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132933",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "glevine1372088@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "10150 SE 32nd Ave",
            "city": "Milwaukie",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972226516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "glevine1372088@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1001 N Providence Dr",
            "city": "Newberg",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971327485",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "glevine1372088@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "727 S Wahanna Rd",
            "city": "Seaside",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971387735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicholas Jonas, MD
• Candie Marie Keller, MSN, APRN, NP-C
• Nancy Keller, MD
• Amanda Krantz, FNP-C
• Gabriela Anna Leon, ARNP-FNP-BC
• Pamela Lewis, RN
• Serena Long
• Jessica Pierrette Miller, MACMHC
• Sarah Miller, MASSAGEGARDEN
• Brock W. Millet, M.D.

• Surgery Physician in Coquille, OR
• Providers in Coquille, OR by specialty
• Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.