Leavitt, Benjamin Glen

Leavitt, Benjamin Glen is an individual health care provider with primary practice located at 203 S Washington Ave Ste A , Aurora MO 65605-1466. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Leavitt, Benjamin Glen can be contacted via phone (417) 678-4022.

Contact Information

Primary practice address
203 S Washington Ave Ste A Aurora MO 65605-1466
Phone: (417) 678-4022
Fax: (417) 678-4025
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2004016417 Missouri

Profile Details

NPI number 1629157359
LBN Legal business name Leavitt, Benjamin Glen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2006
Last updated Mar 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629157359 NPPES
Missouri Other 2004016417 MEDICAL LICENCE NUMBER
Missouri Other 8070773 MEDICAL LICENCE NUMBER

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