Individual
LARRY CORNELIUS LEVERETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4530 E RAY RD, SUITE 140, PHOENIX, AZ 85044-6094
(480) 706-5830
(480) 706-1800
Mailing address
4530 E RAY RD, SUITE 140, PHOENIX, AZ 85044-6094
(480) 706-5830
(480) 706-1800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
119168
AZ
Other
Enumeration date
07/26/2006
Last updated
07/08/2007
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