Individual
BENJAMIN RUSSELL LEAVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 UNIVERSITY AVE, SUITE 220, SACRAMENTO, CA 95825-6504
(916) 286-8700
Mailing address
500 UNIVERSITY AVE, SUITE 220, SACRAMENTO, CA 95825-6504
(916) 286-8700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A070315
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A703150
—
CA
Enumeration date
11/28/2005
Last updated
08/14/2012
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