Individual
DR. GLENN RALPH LEAVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1550 ELK CRK, IDAHO FALLS, ID 83404-8322
(208) 529-5942
(208) 529-5951
Mailing address
1550 ELK CRK, IDAHO FALLS, ID 83404-8322
(208) 535-4580
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
O-0365
ID
Other
Enumeration date
08/01/2005
Last updated
03/01/2012
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