Individual
PETER S LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1473 S HIGHWAY 40 STE E, HEBER CITY, UT 84032-3522
(435) 657-4400
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 657-4400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10696960-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
417210099
—
ME
05
—
500640858
—
OR
Enumeration date
05/20/2006
Last updated
02/15/2021
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