Leavitt, Russell
Leavitt, Russell is an individual health care provider with primary practice located at 1226 Ne 7Th St , Grants Pass OR 97526-1424. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Leavitt, Russell can be contacted via phone (541) 476-6636.Contact Information
Primary practice address
1226 Ne 7Th St
Grants Pass OR 97526-1424
Phone: (541) 476-6636
Fax: (541) 476-6690
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | MD09163 | Oregon |
Profile Details
| NPI number | 1376546614 |
|---|---|
| LBN Legal business name | Leavitt, Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 31st, 2005 |
| Last updated | Feb 11th, 2010 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376546614 | NPPES |
| Oregon | MEDICAID | 111138 |
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