Individual
BRUCE NORMAN LEISTIKOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 SHIELDS AVE, DAVIS, CA 95616-5270
(530) 752-1011
Mailing address
3410 MONTE VISTA AVE, DAVIS, CA 95618-4931
(530) 752-3239
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G80992
CA
2083P0901X
Public Health & General Preventive Medicine Physician
G80992
CA
2083X0100X
Occupational Medicine Physician
Primary
G80992
CA
Other
Enumeration date
08/02/2006
Last updated
02/15/2013
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