Individual
BENJAMIN GLEN LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
203 S WASHINGTON AVE STE A, AURORA, MO 65605-1466
(417) 678-4022
(417) 678-4025
Mailing address
600 W CALE ST, MONETT, MO 65708-2423
(417) 236-9295
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2004016417
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2004016417
MEDICAL LICENCE NUMBER
MO
01
—
8070773
AAFP I.D. NUMBER
MO
Enumeration date
11/03/2006
Last updated
03/07/2023
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