Brent Leavitt

NPI #1740650548 in Chubbuck, Idaho

Provider Information

NPI Number: 1740650548
Entity Type: Individual
Name: Brent Leavitt
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Enumeration Date: Oct 6, 2015
Last Updated: Oct 6, 2015

Practice Location

Address: 4928 PLEASANT VIEW DR
City: Chubbuck
State: Idaho
ZIP Code: 83202-1640
Phone: (208) 760-9416

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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