Individual
DR. EVAN MICHAEL LEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2101 W ARLINGTON BLVD STE 210, GREENVILLE, NC 27834-5758
(252) 931-7638
(529) 317-6942
Mailing address
PO BOX 30750, GREENVILLE, NC 27833-0750
(252) 931-7638
(252) 931-7694
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
MD191804
OR
2085B0100X
Body Imaging Physician
MD60294460
WA
2085R0202X
Diagnostic Radiology Physician
Primary
2022-00758
NC
2085R0202X
Diagnostic Radiology Physician
MD191804
OR
2085R0202X
Diagnostic Radiology Physician
MD60294460
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0334294
L&I-DIAGNOSTIC IMAGING NW
WA
01
—
0369494
L&I-TRA PIERCE COUNTY
WA
01
—
0369496
L&I-TRA KING COUNTY
WA
01
—
0369498
L&I-UAOM
WA
05
—
2020312
—
WA
Enumeration date
06/10/2008
Last updated
04/29/2022
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