Individual
DR. RUSSELL LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1226 NE 7TH ST, GRANTS PASS, OR 97526-1424
(541) 476-6636
(541) 476-6690
Mailing address
1226 NE 7TH ST, GRANTS PASS, OR 97526-1424
(541) 476-6636
(541) 476-6690
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD09163
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111138
—
OR
Enumeration date
05/31/2005
Last updated
02/11/2010
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